Provider Demographics
NPI:1063649911
Name:TATE, DENISE ANN (LVN)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:ANN
Last Name:TATE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 E OHIO AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3439
Mailing Address - Country:US
Mailing Address - Phone:760-745-7786
Mailing Address - Fax:760-745-7786
Practice Address - Street 1:910 E OHIO AVE STE 104
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3439
Practice Address - Country:US
Practice Address - Phone:760-745-7786
Practice Address - Fax:760-745-7786
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN238785164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse