Provider Demographics
NPI:1265024038
Name:DAWSON, ANGELA (CMT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:DAWSON
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9889 GRADUATE DRIVEWAY # 1-401
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-2510
Mailing Address - Country:US
Mailing Address - Phone:858-353-3330
Mailing Address - Fax:
Practice Address - Street 1:9889 GRADUATE DRIVEWAY # 1-401
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-2510
Practice Address - Country:US
Practice Address - Phone:858-353-3330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68160225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist