Basic Information
| Provider Information | |||||||||
| NPI: | 1437196151 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEWART | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | CLAIRE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2668 RIO BRAVO CIR | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958262212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167348397 | ||||||||
| FaxNumber: | 9167345644 | ||||||||
| Practice Location | |||||||||
| Address1: | 3300 STOCKTON BLVD | ||||||||
| Address2: | CAARE DIAGNOSTIC & TREATMENT CENTER | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167348397 | ||||||||
| FaxNumber: | 9167345644 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 08/05/2015 | ||||||||
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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 | 174400000X | G38567 | CA | N | Other Service Providers | Specialist | 208D00000X | G38567 | CA | Y | Allopathic & Osteopathic Physicians | General Practice | 207QA0000X | G38567 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | Adolescent Medicine |
ID Information
| ID | Type | State | Issuer | Description | G38567 | 01 | CA | MEDICAL LICENSE NUMBER | OTHER |