Individual
DANIEL LEE DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
760 WESTWOOD PLAZA, LOS ANGELES, CA 90095-8353
(310) 829-9989
Mailing address
5767 WEST CENTURY BLVD, SUITE 400, LOS ANGELES, CA 90045-5655
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
20A8291
CA
2084P0804X
Child & Adolescent Psychiatry Physician
20A8291
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020A82910
—
CA
05
—
1336349091
—
CA
Enumeration date
07/20/2007
Last updated
10/09/2012
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