Provider Demographics
NPI:1306816905
Name:RADA, DEBORAH R (PHD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:R
Last Name:RADA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1651 MENLO AVE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4911
Mailing Address - Country:US
Mailing Address - Phone:909-389-4513
Mailing Address - Fax:
Practice Address - Street 1:KAISER PERMANENTE MOB 1, 3C
Practice Address - Street 2:9985 SIERRA AVE
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335
Practice Address - Country:US
Practice Address - Phone:909-427-5767
Practice Address - Fax:909-427-4425
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics