| Doctor Name: | DR. WANDA DENISE STREET |
| NPI Number: | 1295918985 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | |
| Business Practice Address: | 102 W Main St San Jacinto, CA - 925834121 |
| Business Phone Number: | 9519292744 |
| Business Fax Number: | |
| Mailing Address: | 5203 El Cerrito Dr Apt 237, RIVERSIDE |
| State: | CA |
| Postal Code: | 925076288 |
| Phone Number: | 9517871952 |
| Fax Number: | |
| NPI Enumeration Date: | 12/17/2007 |
| NPI Last Update Date: | 12/17/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |