Provider Demographics
NPI:1114762754
Name:DOREGIOS, GENISANNE DE OCAMPO
Entity type:Individual
Prefix:
First Name:GENISANNE
Middle Name:DE OCAMPO
Last Name:DOREGIOS
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 1:1401 LOMBARD ST APT 2608
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-8278
Mailing Address - Country:US
Mailing Address - Phone:805-612-4047
Mailing Address - Fax:
Practice Address - Street 1:2625 TOWNSGATE RD STE 102
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-5726
Practice Address - Country:US
Practice Address - Phone:805-413-3009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician