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General NPI Number Information
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NPI Number | 1104072917
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Entity Type | Organization
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Legal Business Name | DENEEN C DICARLO MD INC A PROF CORP
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Dates
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Enumeration Date | 08/12/2008
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Last Update Date | 01/13/2012
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Provider Practice Location Address
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Address Line | 901 OAK PARK BLVD SUITE 101
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City | PISMO BEACH
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State | CA
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Zip | 93449-3408
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Country | US
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Telephone | 805-489-8039
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Fax |
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Provider Business Mailing Address
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Address Line | 901 OAK PARK BLVD SUITE 101
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City | PISMO BEACH
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State | CA
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Zip | 93449-3408
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Country | US
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Telephone | 805-489-8039
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Fax |
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Authorized Official
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Title or Position | RHEUMATOLOGIST
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Name | DR. DENEEN C DICARLO
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Credential | MD
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Telephone | 718-490-7013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | A98771
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License Number State | CA
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