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General NPI Number Information
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NPI Number | 1851950257
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Entity Type | Individual
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Provider Name | STEVEN DANIEL DICKERSON
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Gender | Male
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Dates
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Enumeration Date | 06/10/2019
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 1595 GRAND AVE STE 106
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City | SAN MARCOS
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State | CA
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Zip | 92078-2450
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Country | US
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Telephone | 760-736-6767
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Fax |
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Provider Business Mailing Address
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Address Line | 150 VALPREDA RD
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City | SAN MARCOS
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State | CA
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Zip | 92069-2973
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Country | US
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Telephone | 760-736-6767
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E5874
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License Number State | CA
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