Provider Demographics
NPI:1639573827
Name:DEBLOIS, MARY ELISE (BS)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELISE
Last Name:DEBLOIS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 EAST GISH ROAD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-2406
Mailing Address - Country:US
Mailing Address - Phone:408-453-7616
Mailing Address - Fax:
Practice Address - Street 1:232 EAST GISH ROAD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-2406
Practice Address - Country:US
Practice Address - Phone:408-453-7616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-16
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS65394637171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator