Provider Demographics
NPI:1518608033
Name:ROGERS, DEIRA N
Entity Type:Individual
Prefix:
First Name:DEIRA
Middle Name:N
Last Name:ROGERS
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 1:14080 PALM DRIVE SUITE D
Mailing Address - Street 2:PMB 153
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240
Mailing Address - Country:US
Mailing Address - Phone:760-508-6107
Mailing Address - Fax:
Practice Address - Street 1:13901 CALIENTE DR APT B
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240-5873
Practice Address - Country:US
Practice Address - Phone:760-508-6017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst