Provider Demographics
NPI:1366175770
Name:DIXON, CRYSTAL MENG (PSYD)
Entity type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:MENG
Last Name:DIXON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 MADISON AVE UNIT 230
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-5516
Mailing Address - Country:US
Mailing Address - Phone:619-987-0845
Mailing Address - Fax:
Practice Address - Street 1:7590 FAY AVE STE 401
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4872
Practice Address - Country:US
Practice Address - Phone:510-925-3184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-04
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33452103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical