Provider Demographics
NPI:1104099233
Name:O'LEARY, DENIECE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:DENIECE
Middle Name:
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:854 MAGNOLIA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3109
Mailing Address - Country:US
Mailing Address - Phone:951-737-1454
Mailing Address - Fax:
Practice Address - Street 1:854 MAGNOLIA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3109
Practice Address - Country:US
Practice Address - Phone:951-737-1454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17591363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical