Provider Demographics
NPI:1730315532
Name:GORDON, DEBBIE (ANP-C)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:DEBBIE
Other - Middle Name:
Other - Last Name:DUGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 232410
Mailing Address - Street 2:SUITE ECOB 2-034
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92193-2410
Mailing Address - Country:US
Mailing Address - Phone:619-543-6164
Mailing Address - Fax:
Practice Address - Street 1:9300 CAMPUS POINT DR
Practice Address - Street 2:SUITE ECOB 2-034
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1300
Practice Address - Country:US
Practice Address - Phone:858-657-7100
Practice Address - Fax:858-657-7107
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166102363L00000X
VA0017138075363L00000X
CA13438363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner