Provider Demographics
NPI:1124292891
Name:DEBBIE DENNIS-JOHNSON MD INC.
Entity type:Organization
Organization Name:DEBBIE DENNIS-JOHNSON MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNIS-JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-995-3763
Mailing Address - Street 1:PO BOX 597
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:CA
Mailing Address - Zip Code:93216-0597
Mailing Address - Country:US
Mailing Address - Phone:661-721-0737
Mailing Address - Fax:661-721-0738
Practice Address - Street 1:1201 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-2203
Practice Address - Country:US
Practice Address - Phone:661-721-0737
Practice Address - Fax:661-721-0738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69461207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ31006ZOtherMEDICARE UNSPECIFIED
CA00G694610Medicaid
CAF66464Medicare UPIN