Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist |
NPI | 1073132767 |
---|---|
Provider Name | Dr. Deaunne Denmark |
First Address | La Jolla, CA 92037-7543 |
Second Address | San Jose, CA 95128-5126 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2020 |
Last Update Date | 17/10/2020 |