MEDICARE: SUZANNE D DIXON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0006X	Developmental - Behavioral Pediatrics Physician	C37265	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710988605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE D DIXON MD

Provider Business Mailing Address
First Line	:	3860 CALLE FORTUNADA
Second Line	:	STE 210
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4800
Country	:	US
Telephone Number	:	858-309-6300
Fax Number	:

Provider Business Practice Location Address
First Line	:	7920 FROST ST
Second Line	:	STE 200
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-2736
Country	:	US
Telephone Number	:	858-576-1700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	05/18/2013

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