Healthcare Provider Details

I. General information

NPI: 1023028032
Provider Name (Legal Business Name): ELIZABETH ANN DEBAETS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3230 WARING CT STE P
OCEANSIDE CA
92056-4509
US

IV. Provider business mailing address

2201 MISSION AVE
OCEANSIDE CA
92054-2328
US

V. Phone/Fax

Practice location:
  • Phone: 760-806-5720
  • Fax: 760-726-2637
Mailing address:
  • Phone: 760-806-5720
  • Fax: 760-726-2637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA74866
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: