Provider Demographics
NPI:1295175099
Name:DIXON, TASHA MARIE (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:TASHA
Middle Name:MARIE
Last Name:DIXON
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:MISS
Other - First Name:TASHA
Other - Middle Name:MARIE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1670 E 120TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90059-3026
Mailing Address - Country:US
Mailing Address - Phone:424-338-1000
Mailing Address - Fax:310-223-0663
Practice Address - Street 1:1670 E 120TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059-3026
Practice Address - Country:US
Practice Address - Phone:424-338-1000
Practice Address - Fax:310-223-0663
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA133443207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine