Provider Demographics
NPI:1871705251
Name:TILLEY, DENA D (NP)
Entity type:Individual
Prefix:
First Name:DENA
Middle Name:D
Last Name:TILLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:2050 S BLOSSER RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7310
Mailing Address - Country:US
Mailing Address - Phone:805-361-8028
Mailing Address - Fax:805-361-8097
Practice Address - Street 1:1551 BISHOP ST
Practice Address - Street 2:B240
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4635
Practice Address - Country:US
Practice Address - Phone:805-549-0402
Practice Address - Fax:805-549-0465
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2016-01-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA8147207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0067850Medicaid
CAGR0067850Medicaid