Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | DC26704 | CA |
NPI | 1831291889 |
---|---|
Provider Name | Peter Dawson |
First Address | Montclair, CA 91763-1669 |
Second Address | Montclair, CA 91763-1669 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 20/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ZZZ23594Z | (02) | CA |