Provider Demographics
NPI:1073282729
Name:DICKINSON, MARCELA
Entity Type:Individual
Prefix:
First Name:MARCELA
Middle Name:
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 KINGS COUNTY DR STE 102
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-5954
Mailing Address - Country:US
Mailing Address - Phone:559-415-6737
Mailing Address - Fax:559-422-6114
Practice Address - Street 1:530 KINGS COUNTY DR STE 102
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-5954
Practice Address - Country:US
Practice Address - Phone:559-415-6737
Practice Address - Fax:559-422-6114
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program