Healthcare Provider Details

I. General information

NPI: 1013093558
Provider Name (Legal Business Name): ANTOINE G DIPSIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 02/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4215 NORWOOD AVE #01
W. SACRAMENTO CA
95838-3300
US

IV. Provider business mailing address

200 OCEANGATE #100
LONG BEACH CA
90804-4317
US

V. Phone/Fax

Practice location:
  • Phone: 916-564-0521
  • Fax: 916-564-1528
Mailing address:
  • Phone: 562-499-6191
  • Fax: 562-499-6171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA40970
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: