Desire Sally Derrera | Moreno Valley, CA • PECOS Search

Desire Sally Derrera

Behavior Technician

Behavioral Health & Social Service Providers

12125 Day St Ste 301, Moreno Valley, CA 92557-6702

(951) 344-2166 (818) 345-2345

PECOS Enrollment

Based on the most recent information from CMS, provider Desire Sally Derrera does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1063068336
Provider Type
Individual
Full Name
Derrera, Desire Sally
Title
Ms.
Credential
BS

Gender
Female
Sole Proprietor
No
Enumeration Date
8/13/2019
Last Updated
8/13/2019

Contact Information

Practice Location

12125 Day St Ste 301, Moreno Valley, CA 92557-6702

Unlisted Fax

Mailing Location

21600 Oxnard St Ste 1800, Woodland Hills, CA 91367-7807

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 106S00000X Primary	Description Behavior Technician Behavioral Health & Social Service Providers	License F3612422 California