Healthcare Provider Details

I. General information

NPI: 1760463103
Provider Name (Legal Business Name): DONALD M. DILL, M.D.APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 C. AVE
CORONADO CA
92118-4411
US

IV. Provider business mailing address

171 C. AVE
CORONADO CA
92118-4411
US

V. Phone/Fax

Practice location:
  • Phone: 619-435-4229
  • Fax: 619-435-4275
Mailing address:
  • Phone: 619-435-4229
  • Fax: 619-435-4275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC21783
License Number StateCA

VIII. Authorized Official

Name: DR. DONALD M DILL
Title or Position: OWNER
Credential: M.D.
Phone: 619-435-4229