Healthcare Provider Details

I. General information

NPI: 1134122633
Provider Name (Legal Business Name): DENISE KAYSER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3536 MENDOCINO AVE STE 380
SANTA ROSA CA
95403-3612
US

IV. Provider business mailing address

4045 E UNION HILLS DR STE 115
PHOENIX AZ
85050-3388
US

V. Phone/Fax

Practice location:
  • Phone: 707-575-5353
  • Fax: 707-523-7733
Mailing address:
  • Phone: 602-368-3448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA66761
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number64149
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberA66761
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number64149
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: