Provider Demographics
NPI:1366406555
Name:GATES, DEBORAH L (CERTIFIED ORTHOTIST)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:L
Last Name:GATES
Suffix:
Gender:F
Credentials:CERTIFIED ORTHOTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2602
Mailing Address - Country:US
Mailing Address - Phone:805-643-3537
Mailing Address - Fax:805-643-3568
Practice Address - Street 1:2320 E MAIN ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2602
Practice Address - Country:US
Practice Address - Phone:805-643-3537
Practice Address - Fax:805-643-3568
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC13521174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXA1352100Medicaid
CAXA1352100Medicaid