Healthcare Provider Details

I. General information

NPI: 1992636062
Provider Name (Legal Business Name): DEBORAH SMITH R.N
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81557 DR CARREON BLVD STE B6
INDIO CA
92201-5562
US

IV. Provider business mailing address

81557 DR CARREON BLVD STE B6
INDIO CA
92201-5562
US

V. Phone/Fax

Practice location:
  • Phone: 760-848-4908
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number300053
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: