Provider Demographics
NPI:1639832280
Name:LINAREZ, DEJA MILAN
Entity Type:Individual
Prefix:
First Name:DEJA
Middle Name:MILAN
Last Name:LINAREZ
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 1:3809 KIMBERLY ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-2633
Mailing Address - Country:US
Mailing Address - Phone:510-361-7980
Mailing Address - Fax:
Practice Address - Street 1:3809 KIMBERLY ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-2633
Practice Address - Country:US
Practice Address - Phone:510-361-7980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY5214676103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst