Provider Demographics
NPI:1013005438
Name:MURRAY, DENISE ANNE (RN PHN)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:ANNE
Last Name:MURRAY
Suffix:
Gender:F
Credentials:RN PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 E WASHINGTON BLVD APT F
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-2273
Mailing Address - Country:US
Mailing Address - Phone:626-797-0460
Mailing Address - Fax:213-893-1967
Practice Address - Street 1:311 WINSTON ST
Practice Address - Street 2:LOS ANGELES MISSON COMMUNITY CLINIC
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013
Practice Address - Country:US
Practice Address - Phone:213-893-1960
Practice Address - Fax:213-893-1967
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA644284163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEAP70948FOtherEAPC
CACMM70948FMedicaid
CAW15977Medicare ID - Type Unspecified