Provider Demographics
NPI:1366418865
Name:TENNEN, DEBRA G (MD)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:G
Last Name:TENNEN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:29525 CANWOOD ST
Mailing Address - Street 2:STE 210
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4233
Mailing Address - Country:US
Mailing Address - Phone:818-707-4277
Mailing Address - Fax:818-707-4291
Practice Address - Street 1:29525 CANWOOD ST
Practice Address - Street 2:STE 210
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4231
Practice Address - Country:US
Practice Address - Phone:818-707-4277
Practice Address - Fax:818-707-4291
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2011-09-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG72013207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G720130Medicaid
CABS817ZMedicare PIN
CA00G720130Medicaid