Provider Demographics
NPI:1174539225
Name:CASSIDENTI, DENISE LEE (MD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:LEE
Last Name:CASSIDENTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E 28TH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2773
Mailing Address - Country:US
Mailing Address - Phone:562-427-2229
Mailing Address - Fax:562-427-2751
Practice Address - Street 1:701 E 28TH ST STE 202
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2773
Practice Address - Country:US
Practice Address - Phone:562-427-2229
Practice Address - Fax:562-427-2751
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG057799174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist