Provider Demographics
NPI:1003311986
Name:DIXON, DECEMEI L CALVIN
Entity Type:Individual
Prefix:
First Name:DECEMEI L
Middle Name:CALVIN
Last Name:DIXON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9037 CASALS ST APT 4
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-3209
Mailing Address - Country:US
Mailing Address - Phone:479-841-5840
Mailing Address - Fax:
Practice Address - Street 1:505 M ST
Practice Address - Street 2:
Practice Address - City:RIO LINDA
Practice Address - State:CA
Practice Address - Zip Code:95673-2218
Practice Address - Country:US
Practice Address - Phone:916-287-4067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-24
Last Update Date:2018-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator