Healthcare Provider Details

I. General information

NPI: 1700098597
Provider Name (Legal Business Name): DEBORAH L KAGAY FNP-C, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15414 RIDGEWOOD DR
SONORA CA
95370-8746
US

IV. Provider business mailing address

15414 RIDGEWOOD DR
SONORA CA
95370
US

V. Phone/Fax

Practice location:
  • Phone: 209-536-1425
  • Fax: 209-536-1425
Mailing address:
  • Phone: 209-536-1425
  • Fax: 209-536-1425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number469049
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: