Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 146968 | CA |
Y | 213ES0000X | Sports Medicine | 146968 | CA |
NPI | 1255969143 |
---|---|
Provider Name | Amber Renee Debarge |
First Address | San Diego, CA 92117-1641 |
Second Address | San Diego, CA 92117-1641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2020 |
Last Update Date | 28/03/2020 |