Provider Demographics
NPI:1548035512
Name:LOERA, DALIA AZUCENA I
Entity type:Individual
Prefix:
First Name:DALIA
Middle Name:AZUCENA
Last Name:LOERA
Suffix:I
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 1:1020 HORIZON STREET
Mailing Address - Street 2:
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231
Mailing Address - Country:US
Mailing Address - Phone:760-556-2027
Mailing Address - Fax:
Practice Address - Street 1:1020 HORIZON STREET
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231
Practice Address - Country:US
Practice Address - Phone:760-556-2027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician