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NPI Code Detail

MEDICARE: TYE DEPENA M.D.

MEDICARE: TYE DEPENA M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianA60990CA

General Provider Information

NPI Number : 1467459735
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYE DEPENA M.D.
Provider Business Mailing Address
First Line : DEPT LA 23183
Second Line :
City : PASADENA
State : CA
Zip : 91185-0001
Country : US
Telephone Number : 831-649-1000
Fax Number : 831-649-4966
Provider Business Practice Location Address
First Line : 1505 MAIN ST
Second Line :
City : WATSONVILLE
State : CA
Zip : 95076-3761
Country : US
Telephone Number : 831-722-1444
Fax Number : 831-722-4414
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2005
Last Update Date : 02/08/2010

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