Healthcare Provider Details

I. General information

NPI: 1346830700
Provider Name (Legal Business Name): DEBORAH CARTER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2021
Last Update Date: 01/20/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 I ST
LOS BANOS CA
93635-4143
US

IV. Provider business mailing address

1705 E 23RD ST
MERCED CA
95340-4143
US

V. Phone/Fax

Practice location:
  • Phone: 209-210-2116
  • Fax:
Mailing address:
  • Phone: 510-329-5076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number72664
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: