Provider Demographics
NPI:1689788051
Name:EHRLICH, DENNIS WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:WAYNE
Last Name:EHRLICH
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 1:8950 VILLA LA JOLLA DR STE C129
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1707
Mailing Address - Country:US
Mailing Address - Phone:858-450-5900
Mailing Address - Fax:858-450-5903
Practice Address - Street 1:8950 VILLA LA JOLLA DR STE C129
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1707
Practice Address - Country:US
Practice Address - Phone:858-450-5900
Practice Address - Fax:858-450-5903
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45623207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAE1206300OtherDEA
CAWG45623AMedicare PIN
CAAE1206300OtherDEA