Healthcare Provider Details

I. General information

NPI: 1306034624
Provider Name (Legal Business Name): RHONDA DIXON JD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 CRENSHAW BLVD FL 2
LOS ANGELES CA
90043-1233
US

IV. Provider business mailing address

4715 CRENSHAW BLVD FL 2
LOS ANGELES CA
90043-1233
US

V. Phone/Fax

Practice location:
  • Phone: 323-292-9400
  • Fax:
Mailing address:
  • Phone: 323-292-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: