Provider Demographics
NPI:1063246437
Name:GUNKHASEM, DEEDEE B
Entity type:Individual
Prefix:MRS
First Name:DEEDEE
Middle Name:B
Last Name:GUNKHASEM
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 1:2760 ALFREDA WAY APT B
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1292
Mailing Address - Country:US
Mailing Address - Phone:415-971-1677
Mailing Address - Fax:
Practice Address - Street 1:2760 ALFREDA WAY APT B
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1292
Practice Address - Country:US
Practice Address - Phone:415-971-1677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83458225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist