Provider Demographics
NPI:1538183686
Name:ANZIANO, DEBRA BETH (PA-C)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:BETH
Last Name:ANZIANO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PALOMA DR
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-2016
Mailing Address - Country:US
Mailing Address - Phone:415-609-0015
Mailing Address - Fax:415-927-8145
Practice Address - Street 1:10 PALOMA DR
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-2016
Practice Address - Country:US
Practice Address - Phone:415-609-0015
Practice Address - Fax:415-927-8145
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA011709363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABH486YMedicare PIN