Provider Demographics
NPI:1497847198
Name:DICARLO, DENEEN CHERRY (MD)
Entity Type:Individual
Prefix:DR
First Name:DENEEN
Middle Name:CHERRY
Last Name:DICARLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:DENEEN
Other - Middle Name:CHERRY
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8329 BRIMHALL RD
Mailing Address - Street 2:SUITE 801
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-2243
Mailing Address - Country:US
Mailing Address - Phone:661-695-8385
Mailing Address - Fax:805-439-2765
Practice Address - Street 1:77 CASA ST STE 101
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-5804
Practice Address - Country:US
Practice Address - Phone:661-695-8385
Practice Address - Fax:805-439-2765
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98771207RR0500X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB206701OtherMEDICARE GROUP PTAN
CACB251372OtherMEDICARE INDIVIDUAL PTAN