Healthcare Provider Details

I. General information

NPI: 1760379291
Provider Name (Legal Business Name): ANTHONY DEBIASE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 HOLLYWOOD BLVD UNIT 1225
LOS ANGELES CA
90028-5365
US

IV. Provider business mailing address

6201 HOLLYWOOD BLVD UNIT 1225
LOS ANGELES CA
90028-5365
US

V. Phone/Fax

Practice location:
  • Phone: 917-348-3709
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number95186866
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: