Provider Demographics
NPI:1386613941
Name:STILES, DIXIE (NP)
Entity type:Individual
Prefix:
First Name:DIXIE
Middle Name:
Last Name:STILES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 W LA VETA AVE
Mailing Address - Street 2:SUITE 570
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4300
Mailing Address - Country:US
Mailing Address - Phone:714-835-7700
Mailing Address - Fax:714-835-8145
Practice Address - Street 1:1010 W LA VETA AVE
Practice Address - Street 2:SUITE 570
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4300
Practice Address - Country:US
Practice Address - Phone:714-835-7700
Practice Address - Fax:714-835-8145
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA508290363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACG5665OtherRAIL ROAD MEDICARE - GROUP PTAN
CAW1514OtherMEDICARE PTAN - TYPE 2
CAP00140070OtherRAIL ROAD MEDICARE - PROVIDER PTAN
1912919804OtherNPI - TYPE 2
CAWNP14661AMedicare PIN
CAP00140070OtherRAIL ROAD MEDICARE - PROVIDER PTAN