Provider Demographics
NPI:1740411644
Name:DEANE, MOLLY (MD)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:DEANE
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 1:333 CITY BLVD W STE 705
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2950
Mailing Address - Country:US
Mailing Address - Phone:714-456-5532
Mailing Address - Fax:714-456-7207
Practice Address - Street 1:333 CITY BLVD W STE 705
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2950
Practice Address - Country:US
Practice Address - Phone:714-456-5532
Practice Address - Fax:714-456-7207
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAUNLICENSED208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery