Provider Demographics
NPI:1174330187
Name:DEBOW, ALFRED JASON
Entity type:Individual
Prefix:
First Name:ALFRED
Middle Name:JASON
Last Name:DEBOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3521 LANGDON CMN
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-5403
Mailing Address - Country:US
Mailing Address - Phone:408-483-7384
Mailing Address - Fax:
Practice Address - Street 1:3521 LANGDON CMN
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-5403
Practice Address - Country:US
Practice Address - Phone:408-483-7384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95032194363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care