Healthcare Provider Details

I. General information

NPI: 1255511143
Provider Name (Legal Business Name): DEBORAH ANN LOEHR NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 CAMPANILE DR STUDENT HEALTH SERVICES SDSU
SAN DIEGO CA
92182-4701
US

IV. Provider business mailing address

5500 CAMPANILE DR SDSU STUDENT HEALTH
SAN DIEGO CA
92182-4701
US

V. Phone/Fax

Practice location:
  • Phone: 619-594-7330
  • Fax: 619-594-4260
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number268435
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number553
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: