MEDICARE: LOUIS DEBARRAICUA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A80364	CA

General Provider Information

NPI Number	:	1134154701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUIS DEBARRAICUA M.D.

Provider Business Mailing Address
First Line	:	3325 EL CASTILLO CT
Second Line	:
City	:	ANTELOPE
State	:	CA
Zip	:	95843-4965
Country	:	US
Telephone Number	:	916-723-3775
Fax Number	:	916-727-1906

Provider Business Practice Location Address
First Line	:	6560 GREENBACK LN
Second Line	:	SUITE 200
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95621-6227
Country	:	US
Telephone Number	:	916-727-1989
Fax Number	:	916-727-1906

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	07/09/2007

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