Healthcare Provider Details

I. General information

NPI: 1194967653
Provider Name (Legal Business Name): DIPIKA PANDIT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2009
Last Update Date: 05/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4368 CENTRAL AVE
RIVERSIDE CA
92506-2918
US

IV. Provider business mailing address

4368 CENTRAL AVE
RIVERSIDE CA
92506-2918
US

V. Phone/Fax

Practice location:
  • Phone: 951-742-7324
  • Fax: 951-394-7267
Mailing address:
  • Phone: 951-742-7324
  • Fax: 951-394-7267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA117290
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: