Provider Demographics
NPI:1700807799
Name:MAGNOTTO, DENNIS L (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:L
Last Name:MAGNOTTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:72780 COUNTRY CLUB DR
Mailing Address - Street 2:SUTIE 203
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4126
Mailing Address - Country:US
Mailing Address - Phone:760-674-3847
Mailing Address - Fax:760-674-3845
Practice Address - Street 1:72780 COUNTRY CLUB DR
Practice Address - Street 2:SUTIE 203
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4126
Practice Address - Country:US
Practice Address - Phone:760-674-3847
Practice Address - Fax:760-674-3845
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG86864207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine