Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 20A17849 | CA |
N | 207VX0201X | Gynecologic Oncologist | 20A17849 | CA |
NPI | 1255599130 |
---|---|
Provider Name | Dr. Dennis Charles Desimone |
First Address | Fresno, CA 93721-1431 |
Second Address | Clovis, CA 93611-6889 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2008 |
Last Update Date | 17/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000381 | STATE LICENSE (01) | LA |
2369351 | (05) | LA |