Provider Demographics
NPI:1013164136
Name:DICKEY, MARIA I (DO)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:I
Last Name:DICKEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 LAS POSAS RD
Mailing Address - Street 2:SUITE # 10
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-1501
Mailing Address - Country:US
Mailing Address - Phone:805-918-4476
Mailing Address - Fax:805-981-4478
Practice Address - Street 1:3901 LAS POSAS RD
Practice Address - Street 2:SUITE # 10
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-1501
Practice Address - Country:US
Practice Address - Phone:805-918-4476
Practice Address - Fax:805-981-4478
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A12838207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A12838OtherLICENSE
CAHD743AOtherMEDICARE GROUP PTAN
CAHD743AOtherMEDICARE GROUP PTAN