Provider Demographics
NPI:1649324138
Name:TAY, DEBBIE JOANNA (NP)
Entity type:Individual
Prefix:
First Name:DEBBIE
Middle Name:JOANNA
Last Name:TAY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5978
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92838-0978
Mailing Address - Country:US
Mailing Address - Phone:714-992-5292
Mailing Address - Fax:714-992-1956
Practice Address - Street 1:1301 20TH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2050
Practice Address - Country:US
Practice Address - Phone:310-828-7757
Practice Address - Fax:310-828-6687
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12742363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14606Medicare PIN
CAWNP12742BMedicare ID - Type UnspecifiedMEDICARE PPIN #