Provider Demographics
NPI:1942651732
Name:WIMBERLY, DENZEL
Entity Type:Individual
Prefix:
First Name:DENZEL
Middle Name:
Last Name:WIMBERLY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 NW 19TH ST
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-4849
Mailing Address - Country:US
Mailing Address - Phone:954-729-9422
Mailing Address - Fax:
Practice Address - Street 1:4775 COMMONS DR UNIT DD03
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-4447
Practice Address - Country:US
Practice Address - Phone:954-729-9422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other