Healthcare Provider Details

I. General information

NPI: 1144144692
Provider Name (Legal Business Name): DEBORAH ALEXANDRA BANNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 IMPERIAL HWY
DOWNEY CA
90242-2813
US

IV. Provider business mailing address

2311 4TH ST APT 109
SANTA MONICA CA
90405-3445
US

V. Phone/Fax

Practice location:
  • Phone: 562-922-6111
  • Fax:
Mailing address:
  • Phone: 424-666-4427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberB59BA26721
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: