Provider Demographics
NPI:1124275847
Name:GROMACKI-BLYTH, DEBRA LYNN (PA-C)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:LYNN
Last Name:GROMACKI-BLYTH
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:31720 TEMECULA PKWY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-5802
Mailing Address - Country:US
Mailing Address - Phone:951-303-6900
Mailing Address - Fax:951-303-2900
Practice Address - Street 1:31720 TEMECULA PKWY
Practice Address - Street 2:SUITE 203
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-5802
Practice Address - Country:US
Practice Address - Phone:951-303-6900
Practice Address - Fax:951-303-2900
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2013-05-21
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Provider Licenses
StateLicense IDTaxonomies
CAPA10615363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant