Healthcare Provider Details

I. General information

NPI: 1568523892
Provider Name (Legal Business Name): DEBORAH LYNN KERLIN M.D., F.A.C.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 LA CASA VIA SUITE 340
WALNUT CREEK CA
94598-3091
US

IV. Provider business mailing address

365 LENNON LN SUITE 350
WALNUT CREEK CA
94598-5910
US

V. Phone/Fax

Practice location:
  • Phone: 925-945-7600
  • Fax: 925-945-7664
Mailing address:
  • Phone: 925-932-6330
  • Fax: 925-932-0139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG54324
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: