MEDICARE: DEBORAH ANDERSON

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	363LF0000X	Family Nurse Practitioner	95023452	CA

General Provider Information

NPI Number	:	1578326740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH ANDERSON

Provider Business Mailing Address
First Line	:	PO BOX 35380
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5380
Country	:	US
Telephone Number	:	702-579-3203
Fax Number	:

Provider Business Practice Location Address
First Line	:	10431 LEMON AVE STE N
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91737-3766
Country	:	US
Telephone Number	:	909-466-6579
Fax Number	:	909-466-1389

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

Provider Enumeration Date	:	01/31/2024
Last Update Date	:	12/03/2025

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Directions to “ DEBORAH ANDERSON ” Practice Location

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