Provider Demographics
NPI:1861668865
Name:CORNEJO-VUCOVICH, DENISE (MD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:
Last Name:CORNEJO-VUCOVICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DENISE
Other - Middle Name:
Other - Last Name:CORNEJO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4729 E SUNRISE DR # 336
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-4534
Mailing Address - Country:US
Mailing Address - Phone:520-331-3198
Mailing Address - Fax:
Practice Address - Street 1:520 S EAGLE RD STE 1241
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6355
Practice Address - Country:US
Practice Address - Phone:208-381-6930
Practice Address - Fax:208-381-6931
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ450202086S0102X, 2086S0102X
WY14647C2086S0127X
ID3271447208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery