Provider Demographics
NPI:1205232766
Name:ILDEFONSO, DENISE E (R N)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:E
Last Name:ILDEFONSO
Suffix:
Gender:F
Credentials:R N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 N MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-7554
Mailing Address - Country:US
Mailing Address - Phone:714-319-6919
Mailing Address - Fax:
Practice Address - Street 1:952 N MORGAN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-7554
Practice Address - Country:US
Practice Address - Phone:714-319-6919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-11
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA584807163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse