Healthcare Provider Details

I. General information

NPI: 1003085572
Provider Name (Legal Business Name): BARBARA DENYSIAK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 01/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3969 4TH AVE STE. 203
SAN DIEGO CA
92103-3165
US

IV. Provider business mailing address

3969 4TH AVE STE. 203
SAN DIEGO CA
92103-3165
US

V. Phone/Fax

Practice location:
  • Phone: 619-294-6500
  • Fax: 619-294-6505
Mailing address:
  • Phone: 619-294-6500
  • Fax: 619-294-6505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberA48505
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: