Healthcare Provider Details

I. General information

NPI: 1568509081
Provider Name (Legal Business Name): DENICE STARLEY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 COFFEE RD BLDG 2B
MODESTO CA
95355-4228
US

IV. Provider business mailing address

135 CARMEN LN
SANTA MARIA CA
93458-7729
US

V. Phone/Fax

Practice location:
  • Phone: 209-284-0729
  • Fax: 209-342-6634
Mailing address:
  • Phone: 805-928-7361
  • Fax: 805-332-3750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number1334
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number20A11203
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: