Provider Demographics
NPI:1841465812
Name:JAMES D DIBDIN MD INC
Entity type:Organization
Organization Name:JAMES D DIBDIN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:DIBDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-593-3945
Mailing Address - Street 1:1223 WILSHIRE BLVD # 234
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5406
Mailing Address - Country:US
Mailing Address - Phone:310-593-3945
Mailing Address - Fax:
Practice Address - Street 1:505 COAST BLVD S STE 408
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4613
Practice Address - Country:US
Practice Address - Phone:310-593-3945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39483261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service