Provider Demographics
NPI:1942058169
Name:DONOSO, JOSEFINA DE LOS ANGELES
Entity type:Individual
Prefix:
First Name:JOSEFINA
Middle Name:DE LOS ANGELES
Last Name:DONOSO
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 1:31863 CALLE BALLENTINE
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-6708
Mailing Address - Country:US
Mailing Address - Phone:951-395-3542
Mailing Address - Fax:
Practice Address - Street 1:31863 CALLE BALLENTINE
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-6708
Practice Address - Country:US
Practice Address - Phone:951-395-3542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician