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Individual

JEANNINE DEHARA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
7745 LEEDS ST, DOWNEY, CA 90242-3489
(310) 221-6336
Mailing address
7745 LEEDS ST, DOWNEY, CA 90242-3489
(310) 221-6336

Taxonomy

Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
42894
CA
167G00000X
Licensed Psychiatric Technician
Primary
42894
CA
171M00000X
Case Manager/Care Coordinator

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1487916755
CA
Enumeration date
08/20/2021
Last updated
10/14/2024
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