Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY9247 | CA |
Y | 103T00000X | Psychologist | PSY9247 | CA |
NPI | 1003805938 |
---|---|
Provider Name | Dr. Robert B Dibble |
First Address | Bishop, CA 93514-3566 |
Second Address | Bishop, CA 93514-3566 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2005 |
Last Update Date | 24/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R26744 | (02) | CA |