MEDICARE: DIXIE D RICHARDS MD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	G57309	CA

General Provider Information

NPI Number	:	1528141033
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIXIE D RICHARDS MD INC

Provider Business Mailing Address
First Line	:	11633 SAN VINCENTE BLVD
Second Line	:	SUITE 310
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-6514
Country	:	US
Telephone Number	:	310-826-5949
Fax Number	:	310-826-6239

Provider Business Practice Location Address
First Line	:	11633 SAN VINCENTE BLVD
Second Line	:	SUITE 310
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-6514
Country	:	US
Telephone Number	:	310-826-5949
Fax Number	:	310-826-6239

Authorized Official
Title or Position	:	OWNER
Name	:	DIXIE D RICHARDS
Credential	:	MD
Telephone Number	:	310-826-5949

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	08/22/2020

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