Healthcare Provider Details

I. General information

NPI: 1417914375
Provider Name (Legal Business Name): DEBORAH ANN BEUTLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 04/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 S ARROYO PKWY SUITE 110
PASADENA CA
91105-3263
US

IV. Provider business mailing address

2325 E WOODLYN RD
PASADENA CA
91104-3445
US

V. Phone/Fax

Practice location:
  • Phone: 626-243-5211
  • Fax: 626-844-0399
Mailing address:
  • Phone: 626-797-8399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG067367
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: