Healthcare Provider Details

I. General information

NPI: 1801837331
Provider Name (Legal Business Name): DAVID A DENENHOLZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 E GREEN ST #330
PASADENA CA
91106-2401
US

IV. Provider business mailing address

960 E GREEN ST #330
PASADENA CA
91106-2401
US

V. Phone/Fax

Practice location:
  • Phone: 626-449-4207
  • Fax: 626-449-0925
Mailing address:
  • Phone: 626-449-4207
  • Fax: 626-449-0925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG37998
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: