Healthcare Provider Details

I. General information

NPI: 1649324138
Provider Name (Legal Business Name): DEBBIE JOANNA TAY N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 20TH ST SUITE 400
SANTA MONICA CA
90404-2050
US

IV. Provider business mailing address

PO BOX 5978
FULLERTON CA
92838-0978
US

V. Phone/Fax

Practice location:
  • Phone: 310-828-7757
  • Fax: 310-828-6687
Mailing address:
  • Phone: 714-992-5292
  • Fax: 714-992-1956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number12742
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: