Provider Demographics
NPI:1891266656
Name:ENGELBRITE, DEBRA MARIE (RE)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:MARIE
Last Name:ENGELBRITE
Suffix:
Gender:F
Credentials:RE
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:MARIE
Other - Last Name:KONTOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RE
Mailing Address - Street 1:4100 LUSK DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-0748
Mailing Address - Country:US
Mailing Address - Phone:530-400-2304
Mailing Address - Fax:
Practice Address - Street 1:4100 LUSK DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-0748
Practice Address - Country:US
Practice Address - Phone:530-400-2304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L4144174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist