Healthcare Provider Details

I. General information

NPI: 1275727166
Provider Name (Legal Business Name): JAMES P. DICKENS, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 HOWE AVE BLDG H-50
SACRAMENTO CA
95825-4670
US

IV. Provider business mailing address

701 HOWE AVE BLDG H-50
SACRAMENTO CA
95825-4670
US

V. Phone/Fax

Practice location:
  • Phone: 916-457-7424
  • Fax: 916-457-9212
Mailing address:
  • Phone: 916-457-7424
  • Fax: 916-457-9212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA55172
License Number StateCA

VIII. Authorized Official

Name: DR. JAMES PETER DICKENS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 916-457-7424