1528479383 NPI number — DR. DOROTHY PATRICE DADA MD, PHD

Table of content: DR. DOROTHY PATRICE DADA MD, PHD (NPI 1528479383)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528479383 NPI number — DR. DOROTHY PATRICE DADA MD, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DADA
Provider First Name:
DOROTHY
Provider Middle Name:
PATRICE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARRIS
Provider Other First Name:
DOROTHY
Provider Other Middle Name:
PATRICE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD, PHD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1528479383
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1811 WILSHIRE BLVD STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA MONICA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90403-5626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-829-0260
Provider Business Mailing Address Fax Number:
310-829-0263

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1811 WILSHIRE BLVD STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA MONICA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90403-5626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-829-0260
Provider Business Practice Location Address Fax Number:
310-206-4733
Provider Enumeration Date:
05/14/2014

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: 2084N0400X , with the licence number:  A142739 , 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)





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