Provider Demographics
NPI:1932140910
Name:CARRITTE, DEBORAH MICHELLE CHUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:MICHELLE CHUNG
Last Name:CARRITTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DEBORAH
Other - Middle Name:MICHELLE CHUNG
Other - Last Name:CARRITTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 7081
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92375-0081
Mailing Address - Country:US
Mailing Address - Phone:909-289-7790
Mailing Address - Fax:
Practice Address - Street 1:24785 STEWART ST STE 204
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92350-1721
Practice Address - Country:US
Practice Address - Phone:909-558-0451
Practice Address - Fax:909-651-5809
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG606090207L00000X
CAG60609390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G60690Medicaid
CA1932140901Medicaid
CAE34158Medicare UPIN