Provider Demographics
NPI:1467034579
Name:LOERA, DESIREE MONIQUE
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:MONIQUE
Last Name:LOERA
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 1:14025 CORNUTA AVE
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-2515
Mailing Address - Country:US
Mailing Address - Phone:562-841-0855
Mailing Address - Fax:
Practice Address - Street 1:14025 CORNUTA AVE
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-2515
Practice Address - Country:US
Practice Address - Phone:562-841-0855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician