Healthcare Provider Details

I. General information

NPI: 1376368555
Provider Name (Legal Business Name): DEANNA MORAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5230 VANCE AVE
EUREKA CA
95503-6351
US

IV. Provider business mailing address

5230 VANCE AVE
EUREKA CA
95503-6351
US

V. Phone/Fax

Practice location:
  • Phone: 707-443-4596
  • Fax:
Mailing address:
  • Phone: 707-832-8896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: