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General NPI Number Information
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NPI Number | 1427217512
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Entity Type | Individual
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Provider Name | KATHRYN CAMILLE DIMICELI M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/04/2008
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Last Update Date | 10/07/2020
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Provider Practice Location Address
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Address Line | 83 SCRIPPS DR STE 220
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City | SACRAMENTO
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State | CA
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Zip | 95825-6383
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Country | US
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Telephone | 916-887-7474
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 255228
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City | SACRAMENTO
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State | CA
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Zip | 95865-5228
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Country | US
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Telephone |
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | A133901
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 272291
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 036.125169
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | E-6905
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License Number State | AR
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Taxonomy #5
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MT190975
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License Number State | PA
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