Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | A40970 | CA |
NPI | 1013093558 |
---|---|
Provider Name | Antoine G Dipsia |
First Address | Long Beach, CA 90804-4317 |
Second Address | W. Sacramento, CA 95838-3300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 08/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A409700 | (05) | CA |
00A409700 | MEDI-CAL (01) | CA |
A29259 | (02) | CA |