Healthcare Provider Details

I. General information

NPI: 1497847198
Provider Name (Legal Business Name): DENEEN CHERRY DICARLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DENEEN CHERRY PEREZ MD

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 09/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 CASA ST STE 101
SAN LUIS OBISPO CA
93405-5804
US

IV. Provider business mailing address

8329 BRIMHALL RD SUITE 801
BAKERSFIELD CA
93312-2243
US

V. Phone/Fax

Practice location:
  • Phone: 661-695-8385
  • Fax: 805-439-2765
Mailing address:
  • Phone: 661-695-8385
  • Fax: 805-439-2765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberA98771
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: