Basic Information
| Provider Information | |||||||||
| NPI: | 1083863740 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DECAMBRA | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN, BSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1510 FLORIDA AVE STE H | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953504437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095741030 | ||||||||
| FaxNumber: | 2095741036 | ||||||||
| Practice Location | |||||||||
| Address1: | 1510 FLORIDA AVE STE H | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953504437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095741030 | ||||||||
| FaxNumber: | 2095741036 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2008 | ||||||||
| LastUpdateDate: | 09/17/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC1500X | N7417628 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
No ID Information.