Provider Demographics
NPI:1366011876
Name:DEANE, WYATT ARTHUR
Entity Type:Individual
Prefix:
First Name:WYATT
Middle Name:ARTHUR
Last Name:DEANE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2127 W ORANGEWOOD AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-1978
Mailing Address - Country:US
Mailing Address - Phone:714-673-1936
Mailing Address - Fax:
Practice Address - Street 1:2127 W ORANGEWOOD AVE STE B
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-1978
Practice Address - Country:US
Practice Address - Phone:714-673-1936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician