Provider Demographics
NPI:1760584759
Name:TIBB, DALIP SINGH (MD)
Entity Type:Individual
Prefix:DR
First Name:DALIP
Middle Name:SINGH
Last Name:TIBB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:79430 HIGHWAY 111
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-0569
Mailing Address - Country:US
Mailing Address - Phone:760-625-0569
Mailing Address - Fax:760-777-4339
Practice Address - Street 1:79430 HIGHWAY 111
Practice Address - Street 2:SUITE 102
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-0569
Practice Address - Country:US
Practice Address - Phone:760-625-0569
Practice Address - Fax:760-777-4339
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA065379207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA065379OtherLICENSE
CAA065379OtherLICENSE
CAA065379OtherLICENSE
CAG77657Medicare UPIN