Healthcare Provider Details

I. General information

NPI: 1629221346
Provider Name (Legal Business Name): LAURA MERCEDES DEBROT MARCANO M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2008
Last Update Date: 12/22/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3285 CLAREMONT WAY THE PERMANENTE MEDICAL GROUP INC,
NAPA CA
94558-3313
US

IV. Provider business mailing address

3285 CLAREMONT WAY THE PERMANENTE MEDICAL GROUP INC,
NAPA CA
94558-3313
US

V. Phone/Fax

Practice location:
  • Phone: 707-258-2064
  • Fax: 707-258-4476
Mailing address:
  • Phone: 707-258-2064
  • Fax: 707-258-4476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA134881
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: