Provider Demographics
NPI:1952479164
Name:DINENBERG, L (MD)
Entity Type:Individual
Prefix:
First Name:L
Middle Name:
Last Name:DINENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9834 GENESEE AVE
Mailing Address - Street 2:STE. 125
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1223
Mailing Address - Country:US
Mailing Address - Phone:858-450-1212
Mailing Address - Fax:858-453-9271
Practice Address - Street 1:9834 GENESEE AVE
Practice Address - Street 2:STE. 125
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1223
Practice Address - Country:US
Practice Address - Phone:858-450-1212
Practice Address - Fax:858-453-9271
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG25011207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG25011Medicare PIN