Provider Demographics
NPI:1952463754
Name:MYERS, DENNIS LEE (CPO)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:LEE
Last Name:MYERS
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:MR
Other - First Name:DENNIS
Other - Middle Name:LEE
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPO
Mailing Address - Street 1:9912 BEVERLY LN
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-3839
Mailing Address - Country:US
Mailing Address - Phone:714-590-2241
Mailing Address - Fax:714-636-8881
Practice Address - Street 1:1665 W KATELLA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-3053
Practice Address - Country:US
Practice Address - Phone:714-342-0833
Practice Address - Fax:714-778-4080
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist