Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | DIPLOMA | CA |
NPI | 1225600497 |
---|---|
Provider Name | Lisa Dixon |
First Address | Santa Monica, CA 90405-3792 |
Second Address | Santa Monica, CA 90405-3792 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2021 |
Last Update Date | 15/07/2021 |