Provider Demographics
NPI:1356758833
Name:DALRYMPLE, ITHA (DO)
Entity type:Individual
Prefix:
First Name:ITHA
Middle Name:
Last Name:DALRYMPLE
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:702-843-2420
Mailing Address - Fax:833-749-0351
Practice Address - Street 1:2875 S NELLIS BLVD STE 3
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-2087
Practice Address - Country:US
Practice Address - Phone:702-843-2420
Practice Address - Fax:833-749-0351
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NVDO2250207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1356758833Medicaid
NVDO2250OtherSTATE LICENSE