Provider Demographics
NPI:1588040059
Name:LAVIN, DEBBIE DIANE
Entity Type:Individual
Prefix:MRS
First Name:DEBBIE
Middle Name:DIANE
Last Name:LAVIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEBBIE
Other - Middle Name:DIANE
Other - Last Name:HOLLIDAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27932 PALMETTO RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-1315
Mailing Address - Country:US
Mailing Address - Phone:661-297-6537
Mailing Address - Fax:
Practice Address - Street 1:24868 APPLE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-5037
Practice Address - Country:US
Practice Address - Phone:661-290-2400
Practice Address - Fax:661-290-2400
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61642175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath