Provider Demographics
NPI:1982730230
Name:DIBELLA, GEOFFREY ANGELO (MD)
Entity Type:Individual
Prefix:MR
First Name:GEOFFREY
Middle Name:ANGELO
Last Name:DIBELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 QUAIL ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:714-520-9759
Mailing Address - Fax:949-442-1664
Practice Address - Street 1:1400 QUAIL ST
Practice Address - Street 2:SUITE 150
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:714-520-9759
Practice Address - Fax:949-442-1664
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG216812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B12753Medicare UPIN
G21681Medicare ID - Type Unspecified