1013085810 NPI number — ANDREW S DENNISH MD, FACC

Table of content: ANDREW S DENNISH MD, FACC (NPI 1013085810)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013085810 NPI number — ANDREW S DENNISH MD, FACC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DENNISH
Provider First Name:
ANDREW
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD, FACC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013085810
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1941 JOHNSON AVE
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
SAN LUIS OBISPO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93401-4140
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-782-8844
Provider Business Mailing Address Fax Number:
805-782-8859

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
295 POSADA LN
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
TEMPLETON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93465
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-782-8844
Provider Business Practice Location Address Fax Number:
805-782-8859
Provider Enumeration Date:
12/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  A99253 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00971249 . This is a "RR MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ40450Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR0068680 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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