Provider Demographics
NPI:1548208333
Name:HAMILTON, DENISE (MD)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:HAMILTON
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 1:2701 HARBOR BLVD
Mailing Address - Street 2:E2, SUITE 214
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-5153
Mailing Address - Country:US
Mailing Address - Phone:714-378-1100
Mailing Address - Fax:714-378-1150
Practice Address - Street 1:26732 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE 504
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6306
Practice Address - Country:US
Practice Address - Phone:949-218-9990
Practice Address - Fax:949-218-9991
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55480207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A554800Medicaid
CA00A554800Medicaid
WA55480AMedicare PIN