Healthcare Provider Details

I. General information

NPI: 1013169382
Provider Name (Legal Business Name): DEBORAH BEZONSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 10/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7860 IMPERIAL HWY #C
DOWNEY CA
90242-3464
US

IV. Provider business mailing address

24 HAMMOND UNIT C
IRVINE CA
92618-1680
US

V. Phone/Fax

Practice location:
  • Phone: 562-869-8525
  • Fax: 562-866-7786
Mailing address:
  • Phone: 949-770-6022
  • Fax: 949-770-7084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2643
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: