Provider Demographics
NPI:1699790493
Name:SHIPP, DANA M (MD)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:M
Last Name:SHIPP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 VIA DE LA VALLE
Mailing Address - Street 2:STE 200
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-1992
Mailing Address - Country:US
Mailing Address - Phone:858-499-2702
Mailing Address - Fax:858-309-3119
Practice Address - Street 1:2600 VIA DE LA VALLE
Practice Address - Street 2:STE 200
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-1992
Practice Address - Country:US
Practice Address - Phone:858-499-2702
Practice Address - Fax:858-309-3119
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65056207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACK994ZMedicare Oscar/Certification
CAH22740Medicare UPIN