Provider Demographics
NPI:1528141033
Name:DIXIE D RICHARDS MD INC
Entity type:Organization
Organization Name:DIXIE D RICHARDS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIXIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-826-5949
Mailing Address - Street 1:11633 SAN VINCENTE 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:310-826-5949
Mailing Address - Fax:310-826-6239
Practice Address - Street 1:11633 SAN VINCENTE 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:310-826-5949
Practice Address - Fax:310-826-6239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57309207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty