Healthcare Provider Details

I. General information

NPI: 1063654184
Provider Name (Legal Business Name): CANDICE AUSTIN DENBY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2009
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 CASTRO ST SUITE 410
SAN FRANCISCO CA
94114-1010
US

IV. Provider business mailing address

45 CASTRO ST SUITE 410
SAN FRANCISCO CA
94114-1010
US

V. Phone/Fax

Practice location:
  • Phone: 415-565-6884
  • Fax: 415-600-6886
Mailing address:
  • Phone: 510-428-3885
  • Fax: 510-428-3405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA19889
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: