Provider Demographics
NPI:1629634829
Name:DEERING, BRENDA D (PA)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:D
Last Name:DEERING
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:ATTN CREDENTIALING/PAYER ENROLLMENT
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:575 AUTO CENTER DR
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-3727
Practice Address - Country:US
Practice Address - Phone:831-288-6537
Practice Address - Fax:831-722-2855
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2023-04-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant