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General NPI Number Information
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NPI Number | 1588850309
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Entity Type | Individual
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Provider Name | VICTORIA RITSA DIMITRIADES MD
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Gender | Female
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Dates
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Enumeration Date | 09/16/2007
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Last Update Date | 05/28/2020
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Provider Practice Location Address
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Address Line | 2516 STOCKTON BLVD
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City | SACRAMENTO
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State | CA
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Zip | 95817-2208
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Country | US
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Telephone | 916-734-7618
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Fax | 916-734-7890
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Provider Business Mailing Address
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Address Line | 2516 STOCKTON BLVD
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City | SACRAMENTO
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State | CA
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Zip | 95817-2208
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Country | US
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Telephone | 916-734-7618
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Fax | 916-734-7890
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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 | 2080P0201X
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Taxonomy Name | Pediatric Allergy/Immunology Physician
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License Number | MD.201027
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 2080P0201X
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Taxonomy Name | Pediatric Allergy/Immunology Physician
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License Number | C142141
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License Number State | CA
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