Provider Demographics
NPI:1497860852
Name:RUBIO-DERHAMMER, DEBRA A (FNP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:RUBIO-DERHAMMER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1319
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CA
Mailing Address - Zip Code:95368-1319
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9000 AHWAHNEE DRIVE
Practice Address - Street 2:
Practice Address - City:YOSEMITE NATL PK
Practice Address - State:CA
Practice Address - Zip Code:95389
Practice Address - Country:US
Practice Address - Phone:209-372-4637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA383799163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA383799OtherMEDICAL LICENSE