Healthcare Provider Details

I. General information

NPI: 1063807907
Provider Name (Legal Business Name): DEBRA ANN BEATTY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22349 LA PALMA AVE SUITE 117
YORBA LINDA CA
92887-3823
US

IV. Provider business mailing address

22349 LA PALMA AVE SUITE 117
YORBA LINDA CA
92887-3823
US

V. Phone/Fax

Practice location:
  • Phone: 714-602-9910
  • Fax: 714-602-7150
Mailing address:
  • Phone: 714-269-0765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number615967
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number615967
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number615967
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163WN1003X
TaxonomyNutrition Support Registered Nurse
License Number615967
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number615967
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number615967
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number615967
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number615967
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number615967
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: