Provider Demographics
NPI:1568536316
Name:DAWSON, MAYA (ART PT)
Entity Type:Individual
Prefix:MRS
First Name:MAYA
Middle Name:
Last Name:DAWSON
Suffix:
Gender:F
Credentials:ART PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1658 SOQUEL DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1706
Mailing Address - Country:US
Mailing Address - Phone:831-464-7000
Mailing Address - Fax:831-464-7001
Practice Address - Street 1:1658 SOQUEL DR
Practice Address - Street 2:SUITE H
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1706
Practice Address - Country:US
Practice Address - Phone:831-464-7000
Practice Address - Fax:831-464-7001
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT24328174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist