Doctor Name: | DEBORAH DE LA OSSA |
NPI Number: | 1700230935 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPN |
License Number: | LP049093 |
Business Practice Address: | 2240 Winrow Rd Fort Huachuca, AZ - 856135080 |
Business Phone Number: | 5205339033 |
Business Fax Number: | 5205335328 |
Mailing Address: | 2240 Winrow Rd, FORT HUACHUCA |
State: | AZ |
Postal Code: | 856135080 |
Phone Number: | 5205339033 |
Fax Number: | 5205335328 |
NPI Enumeration Date: | 04/13/2016 |
NPI Last Update Date: | 04/13/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | LP049093 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |