Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | C146669 | CA |
N | 208000000X | Pediatrician | C146669 | CA |
NPI | 1275796419 |
---|---|
Provider Name | Dr. David P. Dimmock |
First Address | San Diego, CA 92123-4232 |
Second Address | San Diego, CA 92123-4232 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2008 |
Last Update Date | 12/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1275796419 | (05) | WI |