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General NPI Number Information
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NPI Number | 1992978274
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Entity Type | Individual
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Provider Name | NATALYA V DENISSOV M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/08/2008
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Last Update Date | 06/22/2020
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Provider Practice Location Address
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Address Line | 1501 TROUSDALE DR 4TH FLOOR
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City | BURLINGAME
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State | CA
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Zip | 94010-4506
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Country | US
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Telephone | 650-652-8500
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Fax |
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Provider Business Mailing Address
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Address Line | 325 DISTEL CIR
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City | LOS ALTOS
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State | CA
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Zip | 94022-1408
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Country | US
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Telephone | 650-652-8501
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A113162
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License Number State | CA
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