Healthcare Provider Details

I. General information

NPI: 1134515851
Provider Name (Legal Business Name): DANIEL SCOTT DODSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 MARINA BAY PKWY
RICHMOND CA
94804-6403
US

IV. Provider business mailing address

850 MARINA BAY PKWY
RICHMOND CA
94804-6403
US

V. Phone/Fax

Practice location:
  • Phone: 858-204-6891
  • Fax:
Mailing address:
  • Phone: 858-204-6891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberDR.0063565
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number172961
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: