Provider Demographics
NPI:1265457436
Name:GARVEY, DENISE SAMANTHA (MD)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:SAMANTHA
Last Name:GARVEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5632
Mailing Address - Country:US
Mailing Address - Phone:310-208-7777
Mailing Address - Fax:310-445-8709
Practice Address - Street 1:11980 SAN VICENTE BLVD
Practice Address - Street 2:102
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-5012
Practice Address - Country:US
Practice Address - Phone:301-208-7777
Practice Address - Fax:310-445-8709
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55477207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A554770Medicaid
CAG67954Medicare UPIN
CABZ185ZMedicare PIN
CAWA55477AMedicare PIN
CAWA55477CMedicare PIN
CAWA55477GMedicare PIN