Active NPI
Gere Stodder Dizerega, MD
- Obstetrics & Gynecology Physician
- Los Angeles, CA
National Provider Identifier
1114278843
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- G30161
- Practice address
- 1321 N Mission Rd
Los Angeles, CA 90033-1020 - Phone
- (323) 226-4965
- NPI assigned
- Sep 20, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | G30161 | CA | Primary |
Addresses
Primary practice location
1321 N Mission Rd
Los Angeles, CA 90033-1020
Mailing address
1321 N. Misson Road
Los Angeles, CA 90033-1020
Phone (323) 226-4965
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G30161 | CA | MD | Obstetrics & Gynecology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348099200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350259200000",
"number": "1114278843",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1321 N. MISSON ROAD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900331020",
"telephone_number": "323-226-4965"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1321 N MISSION RD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900331020",
"telephone_number": "323-226-4965"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIZEREGA",
"first_name": "GERE",
"middle_name": "STODDER",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-09-20",
"last_updated": "2012-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "CA",
"license": "G30161",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.