MEDICARE: ANTONIA B. DEBEVEC MPH, HHP

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	225700000X	Massage Therapist	2004006822	CA

General Provider Information

NPI Number	:	1588810147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONIA B. DEBEVEC MPH, HHP

Provider Business Mailing Address
First Line	:	3802 ROSECRANS ST # 340
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-3114
Country	:	US
Telephone Number	:	619-851-4243
Fax Number	:

Provider Business Practice Location Address
First Line	:	3020 MEADE AVE STE C
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92116-4324
Country	:	US
Telephone Number	:	619-851-4243
Fax Number	:

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

Provider Enumeration Date	:	08/14/2008
Last Update Date	:	08/14/2008

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