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NPI Code Detail

MEDICARE: DEBORAH ANNETTE TRUEBA PT, DPT

MEDICARE: DEBORAH ANNETTE TRUEBA PT, DPT
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
12251X0800XOrthopedic Physical TherapistCA

General Provider Information

NPI Number : 1912482159
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBORAH ANNETTE TRUEBA PT, DPT
Provider Business Mailing Address
First Line : 383 CASPIAN WAY APT 6
Second Line :
City : IMPERIAL BEACH
State : CA
Zip : 91932-3155
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 585 SATURN BLVD STE A
Second Line :
City : SAN DIEGO
State : CA
Zip : 92154-4721
Country : US
Telephone Number : 619-591-1190
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2018
Last Update Date : 10/02/2018

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