1932140910 NPI number — DR. DEBORAH MICHELLE CHUNG CARRITTE M.D.

Table of content: DR. DEBORAH MICHELLE CHUNG CARRITTE M.D. (NPI 1932140910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932140910 NPI number — DR. DEBORAH MICHELLE CHUNG CARRITTE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARRITTE
Provider First Name:
DEBORAH
Provider Middle Name:
MICHELLE CHUNG
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARRITTE
Provider Other First Name:
DEBORAH
Provider Other Middle Name:
MICHELLE CHUNG
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1932140910
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7081
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDLANDS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92375-0081
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-289-7790
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24785 STEWART ST STE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOMA LINDA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92350-1721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-558-0451
Provider Business Practice Location Address Fax Number:
909-651-5809
Provider Enumeration Date:
06/09/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  G606090 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00G60690 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1932140901 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".