Healthcare Provider Details

I. General information

NPI: 1518391713
Provider Name (Legal Business Name): DINA DABBOUS PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2013
Last Update Date: 08/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42021 STATE HIGHWAY 74
HEMET CA
92544-5016
US

IV. Provider business mailing address

42021 STATE HIGHWAY 74
HEMET CA
92544-5016
US

V. Phone/Fax

Practice location:
  • Phone: 951-925-1651
  • Fax: 951-658-3791
Mailing address:
  • Phone: 951-925-1651
  • Fax: 951-658-3791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number68010
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: