Provider Demographics
NPI:1598036436
Name:APODACA, DALE MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:MICHAEL
Last Name:APODACA
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 1:3909 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-1623
Mailing Address - Country:US
Mailing Address - Phone:619-291-5522
Mailing Address - Fax:
Practice Address - Street 1:3909 HENRY ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-1623
Practice Address - Country:US
Practice Address - Phone:619-291-5522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74391207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine