Healthcare Provider Details

I. General information

NPI: 1649448473
Provider Name (Legal Business Name): DEBORAH NICOLE EONTA LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 CAPALINA RD
SAN MARCOS CA
92069-1288
US

IV. Provider business mailing address

1560 CAPALINA RD
SAN MARCOS CA
92069-1288
US

V. Phone/Fax

Practice location:
  • Phone: 760-744-2104
  • Fax: 760-744-1382
Mailing address:
  • Phone: 760-744-2104
  • Fax: 760-744-1382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN222669
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: