Healthcare Provider Details

I. General information

NPI: 1578721122
Provider Name (Legal Business Name): DEBORAH SUZANNE LENT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH SUZANNE GUTIERREZ RN

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 W WARNER AVE
SANTA ANA CA
92707-3147
US

IV. Provider business mailing address

405 W 5TH ST SUITE 522
SANTA ANA CA
92701-4519
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-6915
  • Fax: 714-850-1066
Mailing address:
  • Phone: 714-834-4535
  • Fax: 714-834-5486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number369649
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: