Provider Demographics
NPI:1871721647
Name:PERSICHINO, DENISE RENEE (DO)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:RENEE
Last Name:PERSICHINO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E VANDERBILT WAY
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-0026
Mailing Address - Country:US
Mailing Address - Phone:909-388-0810
Mailing Address - Fax:909-890-0281
Practice Address - Street 1:10737 LAUREL ST STE 230
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-7659
Practice Address - Country:US
Practice Address - Phone:909-989-5556
Practice Address - Fax:909-347-8916
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A98892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry