Provider Demographics
NPI:1497742472
Name:DICKEY, VANESSA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:LYNN
Last Name:DICKEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:DICKEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3285 SKYPARK DR
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5004
Mailing Address - Country:US
Mailing Address - Phone:310-750-3300
Mailing Address - Fax:310-750-3381
Practice Address - Street 1:3285 SKYPARK DR
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5004
Practice Address - Country:US
Practice Address - Phone:310-750-3300
Practice Address - Fax:310-750-3381
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68563207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A68563OtherBLUE SHIELD
WA68563BMedicare ID - Type Unspecified
H91818Medicare UPIN