Provider Demographics
NPI:1164247318
Name:MARUCA, DEBRA
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:MARUCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8181 LA HONDA ROAD
Mailing Address - Street 2:SP 15
Mailing Address - City:LA HONDA
Mailing Address - State:CA
Mailing Address - Zip Code:94020
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8181 LA HONDA ROAD
Practice Address - Street 2:SP 15
Practice Address - City:LA HONDA
Practice Address - State:CA
Practice Address - Zip Code:94020
Practice Address - Country:US
Practice Address - Phone:360-703-4955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider