Provider Demographics
NPI:1619619681
Name:DOHENY, DESHON
Entity Type:Individual
Prefix:
First Name:DESHON
Middle Name:
Last Name:DOHENY
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 1:69175 CONVERSE RD APT 222F
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-7083
Mailing Address - Country:US
Mailing Address - Phone:760-219-0765
Mailing Address - Fax:
Practice Address - Street 1:69175 CONVERSE RD APT 222F
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-7083
Practice Address - Country:US
Practice Address - Phone:760-219-0765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75443225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist