Healthcare Provider Details

I. General information

NPI: 1063420917
Provider Name (Legal Business Name): DEBORAH VANBUREN O.T.R.L.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 LOMA ALTA RD
CARMEL CA
93923
US

IV. Provider business mailing address

39 PADDON RD
WATSONVILLE CA
95076-9042
US

V. Phone/Fax

Practice location:
  • Phone: 831-656-9447
  • Fax: 831-728-2630
Mailing address:
  • Phone: 831-728-2630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOT 6229
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: