Provider Demographics
NPI:1669465951
Name:BUDDIN, DEIDRE ALICE (MD)
Entity Type:Individual
Prefix:DR
First Name:DEIDRE
Middle Name:ALICE
Last Name:BUDDIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3613 VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056
Mailing Address - Country:US
Mailing Address - Phone:760-758-5340
Mailing Address - Fax:760-758-5502
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:530
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:858-558-0677
Practice Address - Fax:858-558-3077
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78688207ND0900X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI27274Medicare UPIN
CAWA78688AMedicare ID - Type UnspecifiedMCARE ID #