Provider Demographics
NPI:1629221346
Name:DEBROT MARCANO, LAURA MERCEDES (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MERCEDES
Last Name:DEBROT MARCANO
Suffix:
Gender:F
Credentials:MD
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Other - Middle Name:
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Mailing Address - Street 1:3285 CLAREMONT WAY
Mailing Address - Street 2:THE PERMANENTE MEDICAL GROUP INC,
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3313
Mailing Address - Country:US
Mailing Address - Phone:707-258-2064
Mailing Address - Fax:707-258-4476
Practice Address - Street 1:3285 CLAREMONT WAY
Practice Address - Street 2:THE PERMANENTE MEDICAL GROUP INC,
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3313
Practice Address - Country:US
Practice Address - Phone:707-258-2064
Practice Address - Fax:707-258-4476
Is Sole Proprietor?:No
Enumeration Date:2008-10-25
Last Update Date:2021-12-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA134881208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03454166Medicaid