Basic Information
| Provider Information | |||||||||
| NPI: | 1114239902 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOLDSTEIN-FUCHS | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | JORDI | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DSC, APRN, NP-C, RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1505 WILSON TER STE 155 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912064032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185004055 | ||||||||
| FaxNumber: | 8185004065 | ||||||||
| Practice Location | |||||||||
| Address1: | 725 WELCH RD | ||||||||
| Address2: | |||||||||
| City: | PALO ALTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 943041601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6504978000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2010 | ||||||||
| LastUpdateDate: | 09/24/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APN001201 | NV | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 95002997 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | ZZZ800032 | 05 | CA | MEDICAID |