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General NPI Number Information
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NPI Number | 1528141033
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Entity Type | Organization
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Legal Business Name | DIXIE D RICHARDS MD INC
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11633 SAN VINCENTE BLVD SUITE 310
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City | LOS ANGELES
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State | CA
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Zip | 90049-6514
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Country | US
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Telephone | 310-826-5949
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Fax | 310-826-6239
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Provider Business Mailing Address
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Address Line | 11633 SAN VINCENTE BLVD SUITE 310
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City | LOS ANGELES
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State | CA
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Zip | 90049-6514
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Country | US
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Telephone | 310-826-5949
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Fax | 310-826-6239
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Authorized Official
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Title or Position | OWNER
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Name | DIXIE D RICHARDS
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Credential | MD
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Telephone | 310-826-5949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | G57309
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License Number State | CA
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