Healthcare Provider Details

I. General information

NPI: 1154055705
Provider Name (Legal Business Name): TAMESHIA DIXON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

CENTRAL VALLEY (MERCED) USE DEPT LA 22763
PASADENA CA
91185-0001
US

IV. Provider business mailing address

DEPT LA 22763
PASADENA CA
91185-2763
US

V. Phone/Fax

Practice location:
  • Phone: 866-523-4268
  • Fax:
Mailing address:
  • Phone: 866-523-4268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-182135
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: