Basic Information
| Provider Information | |||||||||
| NPI: | 1528688298 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIAMEH | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | OHUI | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | NP-F | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 15090 | ||||||||
| Address2: | |||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928035090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145772124 | ||||||||
| FaxNumber: | 7145772125 | ||||||||
| Practice Location | |||||||||
| Address1: | 1211 W LA PALMA AVE STE 404 | ||||||||
| Address2: | |||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928012806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147728282 | ||||||||
| FaxNumber: | 7147726493 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2020 | ||||||||
| LastUpdateDate: | 04/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 95012863 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363LC0200X | 95012863 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 836688 | 01 | CA | CA BOARD OF REGISTERED NURSING | OTHER | 95012863 | 01 | CA | CA BOARD OF REGISTERED NURSING | OTHER | MS5595535 | 01 | CA | DEA | OTHER |