Provider Demographics
NPI:1649540618
Name:DEREGO, ERNESTINE (CADC)
Entity type:Individual
Prefix:
First Name:ERNESTINE
Middle Name:
Last Name:DEREGO
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 SERENO VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1574
Mailing Address - Country:US
Mailing Address - Phone:408-505-4643
Mailing Address - Fax:
Practice Address - Street 1:305 SERENO VISTA WAY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1574
Practice Address - Country:US
Practice Address - Phone:408-505-4643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)