Provider Demographics
NPI:1609843564
Name:DIMEN, LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:
Last Name:DIMEN
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 1:10 CONGRESS ST
Mailing Address - Street 2:SUTIE 208
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3045
Mailing Address - Country:US
Mailing Address - Phone:626-792-2166
Mailing Address - Fax:626-795-0740
Practice Address - Street 1:10 CONGRESS ST
Practice Address - Street 2:SUITE 208
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3045
Practice Address - Country:US
Practice Address - Phone:626-792-2166
Practice Address - Fax:626-795-0740
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76052207RP1001X, 207RC0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G760520Medicaid
CAW481Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
CA00G760520Medicaid