Provider Demographics
NPI:1821270273
Name:FISHER, DENA MARIE (PA,)
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:MARIE
Last Name:FISHER
Suffix:
Gender:F
Credentials:PA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12462 BROOKHURST ST
Mailing Address - Street 2:SUITE A&B
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-4759
Mailing Address - Country:US
Mailing Address - Phone:714-636-9850
Mailing Address - Fax:
Practice Address - Street 1:12462 BROOKHURST ST
Practice Address - Street 2:SUITE A&B
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-4759
Practice Address - Country:US
Practice Address - Phone:714-636-9850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21503363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant