Healthcare Provider Details

I. General information

NPI: 1164631297
Provider Name (Legal Business Name): DEBORAH JOHNSON SPANDIKOW PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S PARKER ST STE 2800
ORANGE CA
92868-4720
US

IV. Provider business mailing address

701 S PARKER ST STE 2800
ORANGE CA
92868-4720
US

V. Phone/Fax

Practice location:
  • Phone: 925-282-1778
  • Fax: 415-296-5299
Mailing address:
  • Phone: 925-282-1778
  • Fax: 415-296-5299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number523239
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number8700
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: