Healthcare Provider Details

I. General information

NPI: 1376366393
Provider Name (Legal Business Name): BISSAN DEBSI FMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

767 BLANDING BLVD STE 103
ORANGE PARK FL
32065-5788
US

IV. Provider business mailing address

1883 W ROYAL HUNTE DR STE 200A
CEDAR CITY UT
84720-4000
US

V. Phone/Fax

Practice location:
  • Phone: 925-577-2651
  • Fax:
Mailing address:
  • Phone: 925-577-2651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: