Healthcare Provider Details

I. General information

NPI: 1174587562
Provider Name (Legal Business Name): DENNIS H NOESEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 LONG BEACH BLVD SUITE 230
LONG BEACH CA
90806-1572
US

IV. Provider business mailing address

2840 LONG BEACH BLVD SUITE 230
LONG BEACH CA
90806-1572
US

V. Phone/Fax

Practice location:
  • Phone: 562-595-1961
  • Fax: 562-595-5351
Mailing address:
  • Phone: 562-595-1961
  • Fax: 562-595-5351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberAN8786242
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberG39916
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: