Provider Demographics
NPI:1164505210
Name:DIXON-PETERS, AISHA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AISHA
Middle Name:
Last Name:DIXON-PETERS
Suffix:
Gender:F
Credentials:PSYD
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 41533
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-0533
Mailing Address - Country:US
Mailing Address - Phone:818-813-2843
Mailing Address - Fax:
Practice Address - Street 1:4405 W RIVERSIDE DR STE 208
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4050
Practice Address - Country:US
Practice Address - Phone:818-813-2843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22768103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical