Individual
DEBRAH BERNICE PENCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RFM
Contact information
Practice address
12402 INDUSTRIAL BLVD, SUITE A-11, VICTORVILLE, CA 92395-5871
(760) 243-6828
(760) 241-2978
Mailing address
12402 INDUSTRIAL BLVD, SUITE A-11, VICTORVILLE, CA 92395-5871
(760) 243-6828
(760) 241-2978
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ52677Z
BLUE SHIELD PROVIDER #
CA
Enumeration date
10/20/2006
Last updated
07/09/2007
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