MEDICARE: MS. DENITHA LOUIS FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	21921	CA

General Provider Information

NPI Number	:	1073856068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DENITHA LOUIS FNP-BC

Provider Business Mailing Address
First Line	:	15218 SUMMIT AVE
Second Line	:	STE 300-318
City	:	FONTANA
State	:	CA
Zip	:	92336-0232
Country	:	US
Telephone Number	:	909-952-3043
Fax Number	:	909-428-6561

Provider Business Practice Location Address
First Line	:	15218 SUMMIT AVE
Second Line	:	STE 300-318
City	:	FONTANA
State	:	CA
Zip	:	92336-0232
Country	:	US
Telephone Number	:	909-952-3043
Fax Number	:	909-428-6561

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2013
Last Update Date	:	10/01/2021

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