1548448970 NPI number — DR. ROBERTA JEAN DUNN-DIXON M.D.

Table of content: DR. ROBERTA JEAN DUNN-DIXON M.D. (NPI 1548448970)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548448970 NPI number — DR. ROBERTA JEAN DUNN-DIXON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUNN-DIXON
Provider First Name:
ROBERTA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DUNN
Provider Other First Name:
ROBERTA
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D,
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1548448970
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18510 MOCKINGBIRD CANYON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92504-9691
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-672-1443
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4443 MAGNOLIA AVE
Provider Second Line Business Practice Location Address:
EMERGENCY DEPARTMENT
Provider Business Practice Location Address City Name:
RIVERSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-788-3200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  A99540 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)