Provider Demographics
NPI:1417055807
Name:SCHEUERELL, DEBORAH K (NP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:K
Last Name:SCHEUERELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 FAIR OAKS AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-5801
Mailing Address - Country:US
Mailing Address - Phone:636-346-5245
Mailing Address - Fax:626-863-9300
Practice Address - Street 1:887 E. SECOND STREET
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-2009
Practice Address - Country:US
Practice Address - Phone:909-620-7769
Practice Address - Fax:877-778-6944
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301492 / 11530363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN301492Medicaid
CAP01272661OtherRAILROAD MEDICARE-DU4032
CABO655XMedicare PIN
CAP01272661OtherRAILROAD MEDICARE-DU4032
CARN301492Medicaid