Provider Demographics
NPI:1891263455
Name:DEGANTE BLANCAS, NOEMI GUADALUPE
Entity type:Individual
Prefix:MISS
First Name:NOEMI
Middle Name:GUADALUPE
Last Name:DEGANTE BLANCAS
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 1:51 REDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-3160
Mailing Address - Country:US
Mailing Address - Phone:714-310-3347
Mailing Address - Fax:
Practice Address - Street 1:51 REDWOOD CT
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-3160
Practice Address - Country:US
Practice Address - Phone:714-310-3347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-12
Last Update Date:2025-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA149946106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist