Healthcare Provider Details

I. General information

NPI: 1053633206
Provider Name (Legal Business Name): MR. DENNIS MALATE REDUBLA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DENNIS MALATE REDUBLA NP

II. Dates (important events)

Enumeration Date: 02/15/2010
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 E HOUSTON AVE
VISALIA CA
93292-2345
US

IV. Provider business mailing address

PO BOX 7410882
CHICAGO IL
60674-0882
US

V. Phone/Fax

Practice location:
  • Phone: 872-231-3162
  • Fax:
Mailing address:
  • Phone: 702-899-0595
  • Fax: 702-977-1496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95004480
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: