Provider Demographics
NPI:1073132767
Name:DENMARK, DEAUNNE (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:DEAUNNE
Middle Name:
Last Name:DENMARK
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5611 BEAUMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-7543
Mailing Address - Country:US
Mailing Address - Phone:503-816-5489
Mailing Address - Fax:
Practice Address - Street 1:373 S MONROE ST STE 202
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-5126
Practice Address - Country:US
Practice Address - Phone:650-993-9123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2020-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics