Healthcare Provider Details

I. General information

NPI: 1861418386
Provider Name (Legal Business Name): TODD A DWELLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 GARDEN RD STE 110
MONTEREY CA
93940-5334
US

IV. Provider business mailing address

4013 LOS ALTOS DR
PEBBLE BEACH CA
93953-3000
US

V. Phone/Fax

Practice location:
  • Phone: 831-372-5841
  • Fax: 831-372-4820
Mailing address:
  • Phone: 831-625-3324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA76923
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: