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General NPI Number Information
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NPI Number | 1003805938
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Entity Type | Individual
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Provider Name | ROBERT B DIBBLE PH.D.
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Gender | Male
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Dates
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Enumeration Date | 10/13/2005
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Last Update Date | 07/24/2013
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Provider Practice Location Address
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Address Line | ALPINE CENTER 375 EAST LINE ST
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City | BISHOP
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State | CA
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Zip | 93514-3566
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Country | US
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Telephone | 760-873-4357
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Fax | 760-873-7446
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Provider Business Mailing Address
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Address Line | ALPINE CENTER 375 EAST LINE ST
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City | BISHOP
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State | CA
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Zip | 93514-3566
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Country | US
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Telephone | 760-873-4357
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Fax | 760-873-7446
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY9247
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License Number State | CA
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