MEDICARE: DEBORAH OWENS COLLINS PA

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	363AM0700X	Medical Physician Assistant	PA11210	CA

General Provider Information

NPI Number	:	1922141936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH OWENS COLLINS PA

Provider Business Mailing Address
First Line	:	1911 SAMARA DR
Second Line	:
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-2511
Country	:	US
Telephone Number	:	626-964-5550
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 GRAND AVE
Second Line	:	STE 106
City	:	LONG BEACH
State	:	CA
Zip	:	90815-1765
Country	:	US
Telephone Number	:	562-570-4379
Fax Number	:

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

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	07/08/2007

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