Provider Demographics
NPI:1104993955
Name:LIVINGSTON, DENNIS P JR (PA)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:P
Last Name:LIVINGSTON
Suffix:JR
Gender:M
Credentials:PA
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Mailing Address - Street 1:9961 SIERRA AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-6720
Mailing Address - Country:US
Mailing Address - Phone:909-427-3118
Mailing Address - Fax:909-427-7602
Practice Address - Street 1:9961 SIERRA AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-6720
Practice Address - Country:US
Practice Address - Phone:909-427-3910
Practice Address - Fax:909-427-7602
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2021-12-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA11206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant