Healthcare Provider Details

I. General information

NPI: 1891796686
Provider Name (Legal Business Name): DEBORAH A ROSKAMP FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12756 VAN NUYS BLVD
PACOIMA CA
91331-1626
US

IV. Provider business mailing address

1172 N MACLAY AVE
SAN FERNANDO CA
91340-1328
US

V. Phone/Fax

Practice location:
  • Phone: 818-896-0531
  • Fax: 818-896-5850
Mailing address:
  • Phone: 818-898-1388
  • Fax: 818-365-4031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4825
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: