Provider Demographics
NPI:1841267960
Name:SWEENEY, DENISE LORA (MEDICAL DOCTOR)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:LORA
Last Name:SWEENEY
Suffix:
Gender:
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6049 DOUGLAS BLVD STE 9
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-6249
Mailing Address - Country:US
Mailing Address - Phone:916-872-1172
Mailing Address - Fax:916-872-1177
Practice Address - Street 1:6049 DOUGLAS BLVD STE 9
Practice Address - Street 2:
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-6249
Practice Address - Country:US
Practice Address - Phone:916-872-1172
Practice Address - Fax:855-435-3153
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79640207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A796400Medicaid
CA00A796400Medicaid
CAH62852Medicare UPIN