Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 036.146945 | IL |
Y | 207K00000X | Allergist & Immunologist | A169117 | CA |
N | 2080P0201X | Pediatric Allergist | 036146945 | IL |
NPI | 1316381650 |
---|---|
Provider Name | Amar Dixit |
First Address | San Bernardino, CA 92423-0069 |
Second Address | Beaumont, CA 92223-3176 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2013 |
Last Update Date | 28/08/2020 |