Provider Demographics
NPI:1255906202
Name:OGOLA, DAPHNEY BEATRICE
Entity type:Individual
Prefix:
First Name:DAPHNEY
Middle Name:BEATRICE
Last Name:OGOLA
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 1:3130 W AVENUE M2
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-2841
Mailing Address - Country:US
Mailing Address - Phone:661-772-3001
Mailing Address - Fax:
Practice Address - Street 1:1216 W AVENUE J STE 100
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2944
Practice Address - Country:US
Practice Address - Phone:818-235-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2022-11-16
Deactivation Date:2022-09-23
Deactivation Code:
Reactivation Date:2022-11-16
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101000-3OtherKAISER