Provider Demographics
NPI:1619041373
Name:DEGOEDE, DANIEL LEON SR (PHD)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:LEON
Last Name:DEGOEDE
Suffix:SR
Gender:M
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 607
Mailing Address - Street 2:
Mailing Address - City:PIONEERTOWN
Mailing Address - State:CA
Mailing Address - Zip Code:92268-0607
Mailing Address - Country:US
Mailing Address - Phone:760-369-9124
Mailing Address - Fax:760-369-9060
Practice Address - Street 1:5476 ROY ROGERS RD.
Practice Address - Street 2:STE D
Practice Address - City:PIONEERTOWN
Practice Address - State:CA
Practice Address - Zip Code:92268-0607
Practice Address - Country:US
Practice Address - Phone:760-269-9124
Practice Address - Fax:760-369-9060
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY9479103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PSY9479OtherONE HEALTH PLAN
PSY9479OtherCONNETICUT GENERAL
PSY9479OtherTHE PRUDENTIAL PPM
PW009479OtherMEDICAL
PSY9479OtherBEECH STREET CAPP CARE
00PL94790OtherBLUE SHIELD OF CALIFORNIA
120229000OtherMAGELLAN
33BEEDOtherRIVERSIDE COUNTY MEDICAL
4039309OtherAETNA US HEALTHCARE
5949OtherHOLMAN GROUP
00PL94790OtherNATIONAL HERITAGE MEDICAR
075112OtherCHAMPUS TRICARE
47183OtherCIGNA
6183175OtherUNITED HEALTHCARE UBH
PSY9479OtherBLUE CROSS OF CALIFORNIA
PSY9479OtherBLUE CROSS OF CALIFORNIA
6183175OtherUNITED HEALTHCARE UBH