Provider Demographics
NPI:1619564127
Name:LIN, DEBRA
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:LIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEBBIE
Other - Middle Name:
Other - Last Name:LIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NCPT
Mailing Address - Street 1:1610 MACKAY LN
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-3719
Mailing Address - Country:US
Mailing Address - Phone:424-262-9968
Mailing Address - Fax:
Practice Address - Street 1:2310 ARTESIA BLVD
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-3114
Practice Address - Country:US
Practice Address - Phone:310-372-2063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty