Provider Demographics
NPI:1235244302
Name:WEST, DENISE AMY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:AMY
Last Name:WEST
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6399 SAN IGNACIO AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1215
Mailing Address - Country:US
Mailing Address - Phone:913-424-4984
Mailing Address - Fax:
Practice Address - Street 1:700 GARDEN VIEW CT STE 100
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2478
Practice Address - Country:US
Practice Address - Phone:760-633-1000
Practice Address - Fax:760-753-8657
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1500805363A00000X
CA60061363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100402570AMedicaid
KSP41026Medicare UPIN
KS042772Medicare ID - Type Unspecified