Provider Demographics
NPI:1720130800
Name:SUSAN DINDOT, MD, APC
Entity Type:Organization
Organization Name:SUSAN DINDOT, MD, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MELISSA
Authorized Official - Last Name:DINDOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-249-9600
Mailing Address - Street 1:30131 TOWN CENTER DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2034
Mailing Address - Country:US
Mailing Address - Phone:949-249-9600
Mailing Address - Fax:949-249-5300
Practice Address - Street 1:30131 TOWN CENTER DR
Practice Address - Street 2:SUITE 140
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2034
Practice Address - Country:US
Practice Address - Phone:949-249-9600
Practice Address - Fax:949-249-5300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65427207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty