MEDICARE: STEPHANIE DEBNATH NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95020789	CA

General Provider Information

NPI Number	:	1548860166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE DEBNATH NP

Provider Business Mailing Address
First Line	:	5226 DEL MORENO DR
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-2428
Country	:	US
Telephone Number	:	626-696-7554
Fax Number	:

Provider Business Practice Location Address
First Line	:	180 S LAKE AVE STE 615
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-4763
Country	:	US
Telephone Number	:	626-683-9158
Fax Number	:	626-683-9207

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2020
Last Update Date	:	07/27/2022

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