Provider Demographics
NPI:1184834699
Name:MUNCHEL, DENETTE (PA)
Entity Type:Individual
Prefix:
First Name:DENETTE
Middle Name:
Last Name:MUNCHEL
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:200 W CENTER STREET PROMENADE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-3960
Mailing Address - Country:US
Mailing Address - Phone:714-449-4841
Mailing Address - Fax:714-449-4956
Practice Address - Street 1:1514 VALLEY VISTA DR
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-3929
Practice Address - Country:US
Practice Address - Phone:909-860-1144
Practice Address - Fax:909-860-8307
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2017-05-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA11622363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR15251Medicare UPIN