Provider Demographics
NPI:1932272382
Name:DENNIS, DEBBIE ANN MARIE
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:ANN MARIE
Last Name:DENNIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEBBIE
Other - Middle Name:
Other - Last Name:DENNIS-JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 597
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:CA
Mailing Address - Zip Code:93216-0597
Mailing Address - Country:US
Mailing Address - Phone:916-863-1375
Mailing Address - Fax:916-967-7167
Practice Address - Street 1:1201 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-2203
Practice Address - Country:US
Practice Address - Phone:661-721-0737
Practice Address - Fax:661-721-0738
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69461207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G694610Medicaid
CA00G694610Medicaid
CAZZZ31006ZMedicare ID - Type Unspecified