Healthcare Provider Details

I. General information

NPI: 1225038235
Provider Name (Legal Business Name): DENNIS UMALI ATIENZA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6072 DOCTORS PARK
MILTON FL
32570-5072
US

IV. Provider business mailing address

6072 DOCTORS PARK
MILTON FL
32570-5072
US

V. Phone/Fax

Practice location:
  • Phone: 850-626-5447
  • Fax: 850-936-5808
Mailing address:
  • Phone: 850-626-5447
  • Fax: 850-936-5808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number02004255
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: