Provider Demographics
NPI:1437594785
Name:DIAMOND, DICKSON STEWART (MD)
Entity Type:Individual
Prefix:DR
First Name:DICKSON
Middle Name:STEWART
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12234 MONTANA AVE
Mailing Address - Street 2:#401
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-5208
Mailing Address - Country:US
Mailing Address - Phone:213-637-3648
Mailing Address - Fax:
Practice Address - Street 1:12234 MONTANA AVE
Practice Address - Street 2:#401
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-5208
Practice Address - Country:US
Practice Address - Phone:213-637-3648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG554952084P0800X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine