Healthcare Provider Details

I. General information

NPI: 1447295860
Provider Name (Legal Business Name): DAVID A DENENHOLZ MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 09/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 E GREEN ST
PASADENA CA
91106-2401
US

IV. Provider business mailing address

960 E GREEN ST STE 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 Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID A DENENHOLZ
Title or Position: PRESIDENT
Credential: MD
Phone: 626-449-4207