Healthcare Provider Details

I. General information

NPI: 1306840186
Provider Name (Legal Business Name): DIXIE IMADA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4748 ENGLE RD STE 103
CARMICHAEL CA
95608-2232
US

IV. Provider business mailing address

4910 PHELPS CT
CARMICHAEL CA
95608-6208
US

V. Phone/Fax

Practice location:
  • Phone: 916-752-9996
  • Fax: 916-486-0188
Mailing address:
  • Phone: 916-359-5244
  • Fax: 916-486-0188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU643
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberHA4075
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: