Individual
JACK MARK DENDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., PSY.D.
Contact information
Practice address
16055 VENTURA BLVD, SUITE 919, ENCINO, CA 91436-2601
(818) 606-8376
(818) 783-4403
Mailing address
1631 ALTA VISTA PL, CAMARILLO, CA 93012-4011
(818) 606-8376
(805) 482-8326
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
A34535
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A034535
MEDICAL BOARD OF QUALITY ASSURANCE
CA
Enumeration date
03/06/2012
Last updated
12/14/2015
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