Healthcare Provider Details

I. General information

NPI: 1982752440
Provider Name (Legal Business Name): KEVIN R DEUTSCHE RPA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 PETALUMA AVE STE B
SEBASTOPOL CA
95472-4225
US

IV. Provider business mailing address

555 PETALUMA AVE STE B
SEBASTOPOL CA
95472-4225
US

V. Phone/Fax

Practice location:
  • Phone: 707-823-7602
  • Fax: 707-823-7625
Mailing address:
  • Phone: 707-823-7602
  • Fax: 707-823-7625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number011652
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA21817
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: