Provider Demographics
NPI:1134109291
Name:DIPP, RANDOLF DWIGHT (DO)
Entity Type:Individual
Prefix:DR
First Name:RANDOLF
Middle Name:DWIGHT
Last Name:DIPP
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1350 COLUMBIA ST
Mailing Address - Street 2:UNIT 800
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-3454
Mailing Address - Country:US
Mailing Address - Phone:619-255-1649
Mailing Address - Fax:619-255-1649
Practice Address - Street 1:1350 COLUMBIA ST
Practice Address - Street 2:UNIT 800
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-3454
Practice Address - Country:US
Practice Address - Phone:619-255-1649
Practice Address - Fax:619-255-1649
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2016-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A80752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry