Provider Demographics
NPI:1730198441
Name:BOSTIC, DEBRA L (RNP)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:L
Last Name:BOSTIC
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9940 TALBERT AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5153
Mailing Address - Country:US
Mailing Address - Phone:714-378-5606
Mailing Address - Fax:714-378-5621
Practice Address - Street 1:9940 TALBERT AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-5153
Practice Address - Country:US
Practice Address - Phone:714-378-5606
Practice Address - Fax:714-378-5621
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6039363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14417Medicare UPIN