Provider Demographics
NPI:1447727409
Name:DILLON, DAVID AUSTIN (MS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:AUSTIN
Last Name:DILLON
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:MIRA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91752-0125
Mailing Address - Country:US
Mailing Address - Phone:909-786-8740
Mailing Address - Fax:
Practice Address - Street 1:41555 COOK ST
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-5184
Practice Address - Country:US
Practice Address - Phone:760-837-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18021235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist