Provider Demographics
NPI:1902978240
Name:BEAN, DEBBIE JENNETTE (BA)
Entity Type:Individual
Prefix:MRS
First Name:DEBBIE
Middle Name:JENNETTE
Last Name:BEAN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9470 MARILLA DR
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92040-2828
Mailing Address - Country:US
Mailing Address - Phone:619-749-1292
Mailing Address - Fax:
Practice Address - Street 1:1105 BROADWAY
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-2767
Practice Address - Country:US
Practice Address - Phone:619-426-4872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator