Provider Demographics
NPI:1740358464
Name:RICHARDS, DIXIE D (MD)
Entity type:Individual
Prefix:
First Name:DIXIE
Middle Name:D
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11633 SAN VICENTE BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-6514
Mailing Address - Country:US
Mailing Address - Phone:310-326-5949
Mailing Address - Fax:310-326-6239
Practice Address - Street 1:11633 SAN VICENTE BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-6514
Practice Address - Country:US
Practice Address - Phone:310-326-5949
Practice Address - Fax:310-326-6239
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57309207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G573090OtherBLUE SHIELD
P00062429OtherRAILROAD MEDICARE
CA00G573090OtherBLUE SHIELD
P00062429OtherRAILROAD MEDICARE