Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | A76850 | CA |
N | 208600000X | Surgeon | A76850 | CA |
Y | 2086S0102X | Surgical Critical Care | A76850 | CA |
N | 2086S0127X | Trauma Surgeon | A76850 | CA |
NPI | 1396703617 |
---|---|
Provider Name | Rochelle Ami Dicker |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Los Angeles, CA 90095-3518 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 23/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020051249 | RAILROAD MEDICARE (01) | CA |
H54043 | (02) | |
OOA768500 | (05) | CA |