Provider Demographics
NPI:1235745696
Name:HOM, DOREEN JOE (LVN, CHES)
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:JOE
Last Name:HOM
Suffix:
Gender:F
Credentials:LVN, CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 CAMINO RAMON
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1354
Mailing Address - Country:US
Mailing Address - Phone:925-244-7349
Mailing Address - Fax:925-244-7254
Practice Address - Street 1:2300 CAMINO RAMON
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1354
Practice Address - Country:US
Practice Address - Phone:925-997-5845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8212174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA946365467Medicaid