Provider Demographics
NPI:1013093558
Name:DIPSIA, ANTOINE G (MD)
Entity Type:Individual
Prefix:
First Name:ANTOINE
Middle Name:G
Last Name:DIPSIA
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 1:200 OCEANGATE #100
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-4317
Mailing Address - Country:US
Mailing Address - Phone:562-499-6191
Mailing Address - Fax:562-499-6171
Practice Address - Street 1:4215 NORWOOD AVE #01
Practice Address - Street 2:
Practice Address - City:W. SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95838-3300
Practice Address - Country:US
Practice Address - Phone:916-564-0521
Practice Address - Fax:916-564-1528
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40970207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A409700Medicaid
CA00A409700OtherMEDI-CAL
CACA926XMedicare PIN
CA00A409700OtherMEDI-CAL
CAA29259Medicare UPIN
CACA926WMedicare PIN
CACA926YMedicare PIN
CACA926ZMedicare PIN