Provider Demographics
NPI:1184794976
Name:COUGHLIN, DENNIS FRANCIS (MD)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:FRANCIS
Last Name:COUGHLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2185 GARNET AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-3603
Mailing Address - Country:US
Mailing Address - Phone:858-270-3767
Mailing Address - Fax:858-270-3770
Practice Address - Street 1:2185 GARNET AVENUE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-3603
Practice Address - Country:US
Practice Address - Phone:858-270-3767
Practice Address - Fax:858-270-3770
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2025-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG17634207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G176340Medicaid
CAG17634Medicare ID - Type Unspecified
CA00G176340Medicaid