Provider Demographics
NPI:1992503346
Name:BOJORQUEZ, DEIDRE LILIA
Entity type:Individual
Prefix:MRS
First Name:DEIDRE
Middle Name:LILIA
Last Name:BOJORQUEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18266 MANZANITA ST
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-4930
Mailing Address - Country:US
Mailing Address - Phone:760-792-3049
Mailing Address - Fax:
Practice Address - Street 1:18266 MANZANITA ST
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-4930
Practice Address - Country:US
Practice Address - Phone:760-792-3049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95033583363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily