Healthcare Provider Details

I. General information

NPI: 1710988605
Provider Name (Legal Business Name): SUZANNE D DIXON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 05/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7920 FROST ST STE 200
SAN DIEGO CA
92123-2736
US

IV. Provider business mailing address

3860 CALLE FORTUNADA STE 210
SAN DIEGO CA
92123-4800
US

V. Phone/Fax

Practice location:
  • Phone: 858-576-1700
  • Fax:
Mailing address:
  • Phone: 858-309-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberC37265
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: