Provider Demographics
NPI:1093740680
Name:DIXON, VARONICA (MD)
Entity Type:Individual
Prefix:DR
First Name:VARONICA
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10069
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92423-0069
Mailing Address - Country:US
Mailing Address - Phone:909-583-2939
Mailing Address - Fax:909-796-4158
Practice Address - Street 1:1690 BARTON RD STE 104
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4230
Practice Address - Country:US
Practice Address - Phone:909-793-2896
Practice Address - Fax:909-796-4158
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68653208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G686530Medicaid
CA00G686530Medicaid