Provider Demographics
NPI:1700396041
Name:GUSS, DEBORAH JEANETA
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:JEANETA
Last Name:GUSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11949 RIVERSIDE DR SPC 53
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92040-2320
Mailing Address - Country:US
Mailing Address - Phone:619-607-1537
Mailing Address - Fax:
Practice Address - Street 1:11949 RIVERSIDE DR SPC 53
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:CA
Practice Address - Zip Code:92040-2320
Practice Address - Country:US
Practice Address - Phone:619-607-1537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-30
Last Update Date:2017-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty