Healthcare Provider Details

I. General information

NPI: 1104822022
Provider Name (Legal Business Name): WENDY SUSAN DENGERINK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 10/08/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 CUYAMACA ST
SANTEE CA
92071
US

IV. Provider business mailing address

8701 CUYAMACA ST
SANTEE CA
92071
US

V. Phone/Fax

Practice location:
  • Phone: 619-568-8025
  • Fax: 619-568-8095
Mailing address:
  • Phone: 619-568-8025
  • Fax: 619-568-8095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA91504
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: