Healthcare Provider Details

I. General information

NPI: 1306952239
Provider Name (Legal Business Name): DEBORAH E ECKLES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 VIA JUANA RD
SANTA YNEZ CA
93460-9679
US

IV. Provider business mailing address

1509 N B CT
LOMPOC CA
93436-3479
US

V. Phone/Fax

Practice location:
  • Phone: 805-688-7070
  • Fax:
Mailing address:
  • Phone: 805-736-1635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number382687
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: