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General NPI Number Information
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NPI Number | 1548534787
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Entity Type | Individual
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Provider Name | JACK MARK DENDER M.D., PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 03/06/2012
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Last Update Date | 12/14/2015
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Provider Practice Location Address
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Address Line | 16055 VENTURA BLVD SUITE 919
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City | ENCINO
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State | CA
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Zip | 91436-2601
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Country | US
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Telephone | 818-606-8376
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Fax | 818-783-4403
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Provider Business Mailing Address
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Address Line | 1631 ALTA VISTA PL
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City | CAMARILLO
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State | CA
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Zip | 93012-4011
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Country | US
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Telephone | 818-606-8376
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Fax | 805-482-8326
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A34535
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License Number State | CA
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