Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | G24509 | CA |
Y | 111NI0900X | Internist | G24509 | CA |
N | 207RA0401X | Internist - Addiction Medicine | G24509 | CA |
NPI | 1467527382 |
---|---|
Provider Name | Dennis Walter Bleakley |
First Address | Commerce, CA 90040-1482 |
Second Address | Los Angeles, CA 90059-3026 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2006 |
Last Update Date | 09/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A42284 | (02) | CA |
WG24509C | PPIN (01) | CA |