Provider Demographics
NPI:1003216482
Name:DORONILA, DENISE MANAS (PA)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:MANAS
Last Name:DORONILA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 LONG POND RD
Mailing Address - Street 2:DEPARTMENT OF SURGERY
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4122
Mailing Address - Country:US
Mailing Address - Phone:585-723-7281
Mailing Address - Fax:585-723-8660
Practice Address - Street 1:500 FIRST ST
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-3742
Practice Address - Country:US
Practice Address - Phone:805-226-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53836363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP01518710OtherMEDICARE RR
NYJ400171029/GRPBA0017Medicare PIN
NYP01518710OtherMEDICARE RR