Healthcare Provider Details

I. General information

NPI: 1528479383
Provider Name (Legal Business Name): DOROTHY PATRICE DADA MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DOROTHY PATRICE HARRIS MD, PHD

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 WILSHIRE BLVD STE 110
SANTA MONICA CA
90403-5626
US

IV. Provider business mailing address

1811 WILSHIRE BLVD STE 110
SANTA MONICA CA
90403-5626
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-0260
  • Fax: 310-206-4733
Mailing address:
  • Phone: 310-829-0260
  • Fax: 310-829-0263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA142739
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: