Provider Demographics
NPI:1538286109
Name:EGAN, DINERY CONCEPCION (MS)
Entity Type:Individual
Prefix:MRS
First Name:DINERY
Middle Name:CONCEPCION
Last Name:EGAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3390 UNIVERSITY AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-3315
Mailing Address - Country:US
Mailing Address - Phone:844-827-8000
Mailing Address - Fax:
Practice Address - Street 1:3390 UNIVERSITY AVE STE 115
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3315
Practice Address - Country:US
Practice Address - Phone:844-827-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 52390106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist