Provider Demographics
NPI:1215603360
Name:ILES, DEJANEE JOANNA (NONE)
Entity Type:Individual
Prefix:
First Name:DEJANEE
Middle Name:JOANNA
Last Name:ILES
Suffix:
Gender:F
Credentials:NONE
Other - Prefix:
Other - First Name:DEJA
Other - Middle Name:
Other - Last Name:ILES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NONE
Mailing Address - Street 1:18726 S WESTERN AVE STE 408
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-3858
Mailing Address - Country:US
Mailing Address - Phone:310-856-0800
Mailing Address - Fax:855-568-2494
Practice Address - Street 1:310 E PALMDALE BLVD STE G
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-7143
Practice Address - Country:US
Practice Address - Phone:661-258-3211
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician