Healthcare Provider Details

I. General information

NPI: 1659343853
Provider Name (Legal Business Name): DEWI FRANCES TONELETE DEPOSITARIO-CABACAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 WEST 1ST STREET
REDFIELD SD
57469-1506
US

IV. Provider business mailing address

PO BOX 590
REDFIELD SD
57469-0590
US

V. Phone/Fax

Practice location:
  • Phone: 605-472-0510
  • Fax: 605-472-0331
Mailing address:
  • Phone: 605-472-0510
  • Fax: 605-472-0331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4766
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: