Provider Demographics
NPI:1487624094
Name:DENMARK, STEVEN MICHAEL
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:MICHAEL
Last Name:DENMARK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 A SAN JOSE ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3934
Mailing Address - Country:US
Mailing Address - Phone:831-754-2238
Mailing Address - Fax:831-754-0629
Practice Address - Street 1:258 SAN JOSE ST
Practice Address - Street 2:STE. A
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3934
Practice Address - Country:US
Practice Address - Phone:831-754-2238
Practice Address - Fax:831-754-0629
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G376600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA47180Medicare UPIN