Provider Demographics
NPI:1588246078
Name:JOHN R. DEBANTO, MD, INC.
Entity type:Organization
Organization Name:JOHN R. DEBANTO, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:DEBANTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-659-7444
Mailing Address - Street 1:435 ARDEN AVE STE 530
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1140
Mailing Address - Country:US
Mailing Address - Phone:818-659-7444
Mailing Address - Fax:818-332-1234
Practice Address - Street 1:435 ARDEN AVE STE 530
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1140
Practice Address - Country:US
Practice Address - Phone:818-659-7444
Practice Address - Fax:818-332-1234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
99999OtherNONE