Provider Demographics
NPI:1619183738
Name:DEBORAH C, HENRY, M.D., APC
Entity Type:Organization
Organization Name:DEBORAH C, HENRY, M.D., APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-390-3125
Mailing Address - Street 1:PO BOX 3545
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-8545
Mailing Address - Country:US
Mailing Address - Phone:626-390-3125
Mailing Address - Fax:949-645-8788
Practice Address - Street 1:11 BALBOA CV
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3226
Practice Address - Country:US
Practice Address - Phone:626-390-3125
Practice Address - Fax:949-645-8788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53188207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A531880Medicaid
C47207Medicare UPIN
CAA53188Medicare ID - Type Unspecified
CA00A531880Medicaid