Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | A99253 | CA |
NPI | 1013085810 |
---|---|
Provider Name | Andrew S Dennish |
First Address | San Luis Obispo, CA 93401-4140 |
Second Address | Templeton, CA 93465 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2006 |
Last Update Date | 25/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
GR0068680 | (05) | CA |
P00971249 | RR MEDICARE (01) | CA |
ZZZ40450Z | BLUE SHIELD (01) | CA |