Provider Demographics
NPI:1487382933
Name:BOGAR, DEJUANNA
Entity type:Individual
Prefix:
First Name:DEJUANNA
Middle Name:
Last Name:BOGAR
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 1:11138 HUEBNER OAKS APT 321
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-1274
Mailing Address - Country:US
Mailing Address - Phone:817-566-5024
Mailing Address - Fax:
Practice Address - Street 1:11138 HUEBNER OAKS APT 321
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-1274
Practice Address - Country:US
Practice Address - Phone:817-566-5024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist