Healthcare Provider Details

I. General information

NPI: 1225819246
Provider Name (Legal Business Name): DESIREE RICHELLE DOUGLAS LPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2023
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 ARNOLD DR STE 261
MARTINEZ CA
94553-6537
US

IV. Provider business mailing address

900 CAMBRIDGE DR UNIT 140
BENICIA CA
94510-3682
US

V. Phone/Fax

Practice location:
  • Phone: 707-210-5444
  • Fax:
Mailing address:
  • Phone: 707-210-5444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: