Provider Demographics
NPI:1053633206
Name:REDUBLA, DENNIS MALATE
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:MALATE
Last Name:REDUBLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DENNIS
Other - Middle Name:MALATE
Other - Last Name:REDUBLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:30 E RIVER PARK PL W STE 320
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-1539
Mailing Address - Country:US
Mailing Address - Phone:559-412-8910
Mailing Address - Fax:559-492-1111
Practice Address - Street 1:30 E RIVER PARK PL W STE 320
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-1539
Practice Address - Country:US
Practice Address - Phone:559-412-8910
Practice Address - Fax:559-492-1111
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-15
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004480363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily