Provider Demographics
NPI:1821279225
Name:DINDOT, SUSAN MELISSA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MELISSA
Last Name:DINDOT
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 1:30131 TOWN CENTER DR STE 140
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2010
Mailing Address - Country:US
Mailing Address - Phone:949-249-9600
Mailing Address - Fax:949-249-5300
Practice Address - Street 1:30131 TOWN CENTER DR STE 140
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2010
Practice Address - Country:US
Practice Address - Phone:949-249-9600
Practice Address - Fax:949-249-5300
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65427207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG28499Medicare UPIN
CAA65427Medicare PIN