Provider Demographics
NPI:1528200888
Name:MARN, DEBRA (LAC, RPH)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:MARN
Suffix:
Gender:F
Credentials:LAC, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7975 JUNE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-3113
Mailing Address - Country:US
Mailing Address - Phone:619-876-6060
Mailing Address - Fax:
Practice Address - Street 1:2831 CAMINO DEL RIO S STE 107
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3827
Practice Address - Country:US
Practice Address - Phone:619-876-6060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 11301171100000X
CA39501183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No183500000XPharmacy Service ProvidersPharmacist