Healthcare Provider Details

I. General information

NPI: 1598902884
Provider Name (Legal Business Name): DEBORAH L. HUSTEAD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2009
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 MCCRAY ST STE 101
HOLLISTER CA
95023-2224
US

IV. Provider business mailing address

3200 BRISTOL ST STE 600
COSTA MESA CA
92626-1810
US

V. Phone/Fax

Practice location:
  • Phone: 831-634-4444
  • Fax: 831-634-4444
Mailing address:
  • Phone: 805-217-7904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number57675
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: