Provider Demographics
NPI:1417431826
Name:POWELL, DAWN ALEXANDRIA
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:ALEXANDRIA
Last Name:POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9716 MOUNTAIN BLVD APT 4
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-4943
Mailing Address - Country:US
Mailing Address - Phone:510-717-3062
Mailing Address - Fax:
Practice Address - Street 1:2730 SHADELANDS DR BLDG 10
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2538
Practice Address - Country:US
Practice Address - Phone:925-266-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator