Provider Demographics
NPI:1376622712
Name:DENES, ALEX (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:DENES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31630 RAILROAD CANYON RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CANYON LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92587-9477
Mailing Address - Country:US
Mailing Address - Phone:951-925-6969
Mailing Address - Fax:951-244-9622
Practice Address - Street 1:31630 RAILROAD CANYON RD
Practice Address - Street 2:SUITE 4
Practice Address - City:CANYON LAKE
Practice Address - State:CA
Practice Address - Zip Code:92587-9477
Practice Address - Country:US
Practice Address - Phone:951-925-6969
Practice Address - Fax:951-244-9622
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-05
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG26977207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA43166Medicare UPIN
CA00G269770Medicare PIN