Provider Demographics
NPI:1225038235
Name:ATIENZA, DENNIS UMALI (DO)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:UMALI
Last Name:ATIENZA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6072 DOCTORS PARK
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-5072
Mailing Address - Country:US
Mailing Address - Phone:850-626-5447
Mailing Address - Fax:850-936-5808
Practice Address - Street 1:6072 DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-5072
Practice Address - Country:US
Practice Address - Phone:850-626-5447
Practice Address - Fax:850-936-5808
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-01
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02004255207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000833372OtherBLUE CROSS/BLUE SHIELD
IN201182850Medicaid
IN201182850Medicaid
IN000000833372OtherBLUE CROSS/BLUE SHIELD