Provider Demographics
NPI:1447958889
Name:DEJOHNETTE, PAULANA-VIVIANA
Entity type:Individual
Prefix:
First Name:PAULANA-VIVIANA
Middle Name:
Last Name:DEJOHNETTE
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 1:905 LA CANADA VERDUGO RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-1016
Mailing Address - Country:US
Mailing Address - Phone:626-842-7550
Mailing Address - Fax:
Practice Address - Street 1:691 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-2021
Practice Address - Country:US
Practice Address - Phone:626-842-7550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator