Basic Information
Provider Information
NPI: 1720292485
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LIGON
FirstName: DEBORAH
MiddleName: C.
NamePrefix: MRS.
NameSuffix:  
Credential: N.P.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 9602
Address2:  
City: MISSION HILLS
State: CA
PostalCode: 913469602
CountryCode: US
TelephoneNumber: 8188375559
FaxNumber: 8187924793
Practice Location
Address1: 11333 SEPULVEDA BLVD
Address2:  
City: MISSION HILLS
State: CA
PostalCode: 913451116
CountryCode: US
TelephoneNumber: 8183659531
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/10/2007
LastUpdateDate: 11/16/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0200X14350CAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics

No ID Information.


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