Provider Demographics
NPI:1578044764
Name:INOCENCIO, DIONISIA MARIA
Entity Type:Individual
Prefix:MRS
First Name:DIONISIA
Middle Name:MARIA
Last Name:INOCENCIO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DIONISIA
Other - Middle Name:MARIA
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PPS
Mailing Address - Street 1:24823 SOTO RD
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-1931
Mailing Address - Country:US
Mailing Address - Phone:510-723-3857
Mailing Address - Fax:
Practice Address - Street 1:24823 SOTO RD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544
Practice Address - Country:US
Practice Address - Phone:510-723-3857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool