Provider Demographics
NPI:1528018843
Name:DIXON, NEAL P
Entity Type:Individual
Prefix:DR
First Name:NEAL
Middle Name:P
Last Name:DIXON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2438 N PONDEROSA DR
Mailing Address - Street 2:SUITE C-207
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-2369
Mailing Address - Country:US
Mailing Address - Phone:805-484-3513
Mailing Address - Fax:805-484-3961
Practice Address - Street 1:2438 N PONDEROSA DR
Practice Address - Street 2:SUITE C-207
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2369
Practice Address - Country:US
Practice Address - Phone:805-484-3513
Practice Address - Fax:805-484-3961
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46609208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0030880Medicaid
CAA92660Medicare UPIN
CAGR0030880Medicaid