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NPI Code Detail

MEDICARE: DEBRA SUE GOETTSCH P.A.-C

MEDICARE: DEBRA SUE GOETTSCH P.A.-C
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
1363A00000XPhysician AssistantPA13453CA

General Provider Information

NPI Number : 1841202165
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBRA SUE GOETTSCH P.A.-C
Provider Business Mailing Address
First Line : 1801 SHATTUCK AVE STE A
Second Line :
City : BERKELEY
State : CA
Zip : 94709-1872
Country : US
Telephone Number : 510-225-1025
Fax Number : 510-225-0119
Provider Business Practice Location Address
First Line : 1801 SHATTUCK AVE STE A
Second Line :
City : BERKELEY
State : CA
Zip : 94709-1872
Country : US
Telephone Number : 510-225-1025
Fax Number : 510-225-0119
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2006
Last Update Date : 04/10/2015

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Directions to “ DEBRA SUE GOETTSCH P.A.-C” Practice Location

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