Provider Demographics
NPI:1154459774
Name:DAWES, DIANNE MARIE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:MARIE
Last Name:DAWES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2342 PROFESSIONAL PKWY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-1629
Mailing Address - Country:US
Mailing Address - Phone:805-934-2488
Mailing Address - Fax:
Practice Address - Street 1:2342 PROFESSIONAL PKWY
Practice Address - Street 2:SUITE 310
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-1629
Practice Address - Country:US
Practice Address - Phone:805-934-2488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14568363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA14568OtherPA LICENSE