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General NPI Number Information
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NPI Number | 1043006596
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Entity Type | Individual
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Provider Name | CLAIRE MINA DICKE
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Gender | Female
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Dates
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Enumeration Date | 04/18/2025
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 1075 E BETTERAVIA RD STE 201
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City | SANTA MARIA
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State | CA
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Zip | 93454-7023
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Country | US
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Telephone | 805-621-7651
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Fax |
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Provider Business Mailing Address
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Address Line | 3095 OUTLOOK DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80921-2016
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Country | US
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Telephone | 719-722-4006
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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