Individual
DENISE PROVOST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
795 EL CAMINO REAL, PALO ALTO, CA 94301-2302
(650) 853-2398
Mailing address
325 DISTEL CIR, LOS ALTOS, CA 94022-1408
(650) 853-2970
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A81016
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A810160
—
CA
Enumeration date
09/13/2006
Last updated
06/04/2020
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