| R D Dipp Do | |
|
1350 Columbia St Unit 800 San Diego CA 92101-3454 | |
| (619) 255-1649 | |
| (619) 255-1649 |
| Full Name | R D Dipp Do |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1350 Columbia St, San Diego, California |
| Authorized Official Name and Position | Randolf Dipp (PRESIDENT) |
| Authorized Official Contact | 6192444420 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| R D Dipp Do 1350 Columbia St Unit 800 San Diego CA 92101-3454 Ph: (619) 255-1649 | R D Dipp Do 1350 Columbia St Unit 800 San Diego CA 92101-3454 Ph: (619) 255-1649 |
| NPI Number | 1003261355 |
|---|---|
| Provider Enumeration Date | 04/24/2016 |
| Last Update Date | 05/03/2024 |
| Certification Date | 05/03/2024 |
| Medicare PECOS PAC ID | 3072871979 |
|---|---|
| Medicare Enrollment ID | O20171226001363 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003261355 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 20A8075 (California) | Primary |
| Provider Name | Randolf Dwight Dipp |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1134109291 PECOS PAC ID: 4981962883 Enrollment ID: I20171226001408 |
| Provider Name | Zohreh Kermani |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1538574645 PECOS PAC ID: 2466855218 Enrollment ID: I20210730001734 |
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