MEDICARE: MRS. GUADALUPE E. DENETTE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1679607345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GUADALUPE E. DENETTE

Provider Business Mailing Address
First Line	:	1911 WILLIAMS DR STE 110
Second Line	:	VENTURA COUNTY BEHAVIORAL HEALTH DEPARTMENT
City	:	OXNARD
State	:	CA
Zip	:	93036-2665
Country	:	US
Telephone Number	:	805-981-4200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1911 WILLIAMS DR STE 110
Second Line	:	VENTURA COUNTY BEHAVIORAL HEALTH DEPARTMENT
City	:	OXNARD
State	:	CA
Zip	:	93036-2665
Country	:	US
Telephone Number	:	805-981-4200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	07/08/2007

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