Provider Demographics
NPI:1285215046
Name:RANDLES, DAEJA S
Entity Type:Individual
Prefix:
First Name:DAEJA
Middle Name:S
Last Name:RANDLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2437 SANTA ANA AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6533
Mailing Address - Country:US
Mailing Address - Phone:559-917-3443
Mailing Address - Fax:559-294-5946
Practice Address - Street 1:64 E WELDON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-5956
Practice Address - Country:US
Practice Address - Phone:559-442-1947
Practice Address - Fax:559-294-5946
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor