Provider Demographics
NPI:1780862169
Name:ANGHESOM-NEGUSSE, DEBORAH (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:ANGHESOM-NEGUSSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:ANGHESOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8221 ROCHESTER AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-0721
Mailing Address - Country:US
Mailing Address - Phone:909-360-1111
Mailing Address - Fax:833-989-2428
Practice Address - Street 1:8221 ROCHESTER AVE STE 130
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0721
Practice Address - Country:US
Practice Address - Phone:909-360-1111
Practice Address - Fax:833-989-2428
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95164207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology