Provider Demographics
NPI:1922231083
Name:DEUDOR, DENNIA
Entity Type:Individual
Prefix:MR
First Name:DENNIA
Middle Name:
Last Name:DEUDOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804-1910
Mailing Address - Country:US
Mailing Address - Phone:510-231-7812
Mailing Address - Fax:510-231-7810
Practice Address - Street 1:84 BROADWAY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-1910
Practice Address - Country:US
Practice Address - Phone:510-231-7812
Practice Address - Fax:510-231-7810
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health