Provider Demographics
NPI:1700636297
Name:HENDERSON, DIONNE REONDA
Entity Type:Individual
Prefix:MRS
First Name:DIONNE
Middle Name:REONDA
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DIONNE
Other - Middle Name:REONDA
Other - Last Name:SEARLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 W BRAZIL ST
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-1720
Mailing Address - Country:US
Mailing Address - Phone:442-235-8415
Mailing Address - Fax:
Practice Address - Street 1:1001 W BRAZIL ST
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-1720
Practice Address - Country:US
Practice Address - Phone:442-235-8415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172A00000X
CAA3320972172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty