Provider Demographics
NPI:1073951398
Name:BOOMAN, DEBRA ANN (DVM)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:ANN
Last Name:BOOMAN
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 BAUTISTA AVE
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-1641
Mailing Address - Country:US
Mailing Address - Phone:760-630-2250
Mailing Address - Fax:760-631-7501
Practice Address - Street 1:2302 BAUTISTA AVE
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-1641
Practice Address - Country:US
Practice Address - Phone:760-630-2250
Practice Address - Fax:760-631-7501
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-09
Last Update Date:2013-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9181174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian