Provider Demographics
NPI:1417053257
Name:ALBURY, DENISE ANTOINETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:ANTOINETTE
Last Name:ALBURY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5550 S VERDUN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-1525
Mailing Address - Country:US
Mailing Address - Phone:310-419-2223
Mailing Address - Fax:310-419-2226
Practice Address - Street 1:133 N PRAIRIE AVE
Practice Address - Street 2:STE B
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4878
Practice Address - Country:US
Practice Address - Phone:310-419-2223
Practice Address - Fax:310-419-2226
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74533208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ416570Medicaid
CA00G745330Medicaid
NMR8765Medicaid