Provider Demographics
NPI:1235649039
Name:BRODSKY, DENNIS EUGENE (PA-C)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:EUGENE
Last Name:BRODSKY
Suffix:
Gender:M
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 1:2015 WOODLAND HEIGHTS GLN
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-5002
Mailing Address - Country:US
Mailing Address - Phone:760-520-3417
Mailing Address - Fax:
Practice Address - Street 1:3142 VISTA WAY STE 207
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-3628
Practice Address - Country:US
Practice Address - Phone:760-610-0522
Practice Address - Fax:760-610-0523
Is Sole Proprietor?:No
Enumeration Date:2017-10-06
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant