Basic Information
| Provider Information | |||||||||
| NPI: | 1912482159 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRUEBA | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | ANNETTE | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 383 CASPIAN WAY APT 6 | ||||||||
| Address2: | |||||||||
| City: | IMPERIAL BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919323155 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 585 SATURN BLVD STE A | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921544721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195911190 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2018 | ||||||||
| LastUpdateDate: | 10/02/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.