MEDICARE: DENALI TICE 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
1	2084P0800X	Psychiatry Physician	A127567	CA

General Provider Information

NPI Number	:	1508124660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENALI TICE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 803
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95763-0803
Country	:	US
Telephone Number	:	916-400-9037
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 IRON POINT RD
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95630-9009
Country	:	US
Telephone Number	:	916-400-9037
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2012
Last Update Date	:	02/17/2026

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