DESIREE PROVENCIO (NPI# 1205023447) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205023447 |
| Entity Type | Individual |
| Full Name | DESIREE PROVENCIO |
| Practice Address |
24625 Arch St Santa Clarita CA 91321-1111 |
| Mailing Address |
26460 Summit Cir Santa Clarita CA 91350-2991 |
| Practice Telephone | 6612546630 |
| Enumeration Date | 2007-10-02 |
| Last Update Date | 2007-10-02 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336648328 | Desiree Renee Provencio | Nurse Practitioner | 184 Unser Blvd Ne, Rio Rancho, NM 87124-4045 | 2018-02-06 |
| Street Address |
24625 ARCH ST |
| City | SANTA CLARITA |
| State | CA |
| Zip Code | 91321-1111 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548612476 | Keisa Christine Desouza | Licensed Vocational Nurse | 24625 Arch St, Santa Clarita, CA 91321-1111 | 2016-07-03 |
| 1851705909 | Eldorado Community Service Center | Health Maintenance Organization | 24625 Arch St, Santa Clarita, CA 91321-1111 | 2014-06-17 |
| 1427230192 | Guy Ballard | Counselor | 24625 Arch St, Santa Clarita, CA 91321-1111 | 2007-12-04 |
| 1386831535 | Derrick Fortune | Counselor | 24625 Arch St, Santa Clarita, CA 91321-1111 | 2007-10-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275157265 | Lauren Tolcher | Behavioral Analyst | 23502 Lyons Avenue, Suite 304a, Santa Clarita, CA 91321 | 2020-06-04 |
| 1427613900 | Weston William Lensing | Behavior Technician | 3502 Lyons Ave, Ste 304a, Santa Clarita, CA 91321 | 2019-05-09 |
| 1174005003 | Eparthenos | Psychologist | 23504 Lyons Ave #304, Santa Clarita, CA 91321 | 2018-09-06 |
| 1740761105 | The Center for Creative Therapy, Inc | Marriage & Family Therapist | 23030 Lyons Ave Ste 207, Santa Clarita, CA 91321 | 2018-08-23 |
| 1982196879 | Brandi Wright-dohopolski | Acupuncturist | 27820 Freemont Court, Unit 5, Suite E, Valencia, CA 91321 | 2018-06-06 |
| 1780113209 | Jennifer Ann Woods | Physician Assistant | 23645 Meadowridge Drive, 110, Newhall, CA 91321 | 2017-06-08 |
| 1942661624 | Sina Tebi Md Inc | Internal Medicine | 23938 Lyons Avenue, #204, Newhall, CA 91321 | 2016-03-09 |
| 1720452220 | Julie Kim | Pharmacist | 26863 Sierra Hwy, Santa Clarita, CA 91321 | 2015-11-20 |
| 1568855773 | Carly Nikiforuk | Counselor | 24625 Arch St., Newhall, CA 91321 | 2015-03-12 |
| 1437562741 | Teresa Cha Waggoner | Nurse Practitioner | 23772 Newhall Avenue, Newhall, CA 91321 | 2014-06-04 |
| Find all providers in zip 91321 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720550874 | Jessica Lara | Counselor | 22519 Garzota Dr, Santa Clarita, CA 91350-2247 | 2018-12-28 |
| 1548680523 | Gwendolyn Macdonald | Counselor | 26708 Oak Pluma Ct, Santa Clarita, CA 91321-1441 | 2014-04-17 |
| 1134323645 | Mayra Arambula | Counselor | 21754 Fritz Way, Santa Clarita, CA 91390-5717 | 2007-06-11 |
| 1568925931 | Cyrush Akbar | Counselor | 21545 Centre Pointe Pkwy, Santa Clarita, CA 91350-2947 | 2019-04-11 |
| 1780145029 | Amanda Ellis | Counselor | 21545 Centre Pointe Pkwy, Santa Clarita, CA 91350-2947 | 2019-03-28 |
| 1639647910 | Megan Brooke Stewart | Counselor | 24460 Lyons Ave, Santa Clarita, CA 91321-2347 | 2018-11-05 |
| 1760959597 | Derek Bourdess | Counselor | 24460 Lyons Ave, Santa Clarita, CA 91321-2347 | 2018-10-30 |
| 1699269662 | Oscar Alvarez | Counselor | 24460 Lyons Ave, Santa Clarita, CA 91321-2347 | 2018-06-21 |
| 1619489382 | Jodi Sharp | Counselor | 24460 Lyons Ave, Santa Clarita, CA 91321-2347 | 2017-11-02 |
| 1235662990 | Joshua Davis | Counselor | 38215 San Francisquito Canyon Rd, Santa Clarita, CA 91390-4914 | 2017-04-09 |
| Find all providers in SANTA CLARITA | ||||
| City | SANTA CLARITA |
| Zip Code | 91321 |
Please comment or provide details below to improve the information on DESIREE PROVENCIO.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.