Provider Demographics
NPI:1063420917
Name:VANBUREN, DEBORAH (OTRL)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:
Last Name:VANBUREN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 PADDON RD
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-9042
Mailing Address - Country:US
Mailing Address - Phone:831-728-2630
Mailing Address - Fax:
Practice Address - Street 1:524 LOMA ALTA RD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923
Practice Address - Country:US
Practice Address - Phone:831-656-9447
Practice Address - Fax:831-728-2630
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 6229174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist