Provider Demographics
NPI:1306840186
Name:IMADA, DIXIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIXIE
Middle Name:
Last Name:IMADA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4910 PHELPS CT
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-6208
Mailing Address - Country:US
Mailing Address - Phone:916-359-5244
Mailing Address - Fax:916-486-0188
Practice Address - Street 1:4748 ENGLE RD
Practice Address - Street 2:STE 103
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-2232
Practice Address - Country:US
Practice Address - Phone:916-752-9996
Practice Address - Fax:916-486-0188
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU643231H00000X
CAHA4075237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU0006430Medicaid