Provider Demographics
NPI:1629629498
Name:DIPACE, DOROTHY A
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:A
Last Name:DIPACE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 LA MELODIA DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-7097
Mailing Address - Country:US
Mailing Address - Phone:575-636-8203
Mailing Address - Fax:
Practice Address - Street 1:661 LA MELODIA DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-7097
Practice Address - Country:US
Practice Address - Phone:575-636-8203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider