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General NPI Number Information
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NPI Number | 1518184886
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Entity Type | Organization
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Legal Business Name | PATTIE J DIMMETTE M D A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 05/16/2019
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Provider Practice Location Address
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Address Line | 25405 HANCOCK AVE STE 101
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City | MURRIETA
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State | CA
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Zip | 92562-5978
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Country | US
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Telephone | 951-461-3311
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Fax | 951-461-2833
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Provider Business Mailing Address
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Address Line | 13406 LANDFAIR RD
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City | SAN DIEGO
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State | CA
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Zip | 92130-1839
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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 | OWNER
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Name | PATTIE JEAN DIMMETTE
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Credential | M.D.
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Telephone | 951-461-3311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | G66939
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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