Provider Demographics
NPI:1013085810
Name:DENNISH, ANDREW S (MD, FACC)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:S
Last Name:DENNISH
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 JOHNSON AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4140
Mailing Address - Country:US
Mailing Address - Phone:805-782-8844
Mailing Address - Fax:805-782-8859
Practice Address - Street 1:295 POSADA LN
Practice Address - Street 2:SUITE A
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465
Practice Address - Country:US
Practice Address - Phone:805-782-8844
Practice Address - Fax:805-782-8859
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99253207RC0000X, 207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00971249OtherRR MEDICARE
CAZZZ40450ZOtherBLUE SHIELD
CAGR0068680Medicaid
CAGR0068680Medicaid
CAP00971249OtherRR MEDICARE
CAZZZ40450ZOtherBLUE SHIELD
CABM907UMedicare PIN
CAZZZ40450ZOtherBLUE SHIELD