Provider Demographics
NPI:1689805798
Name:LAWSON, BRIAN EDWIN (RD)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:EDWIN
Last Name:LAWSON
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 VALE RD
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3808
Mailing Address - Country:US
Mailing Address - Phone:510-970-5383
Mailing Address - Fax:510-970-5743
Practice Address - Street 1:2000 VALE RD
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3808
Practice Address - Country:US
Practice Address - Phone:510-970-5383
Practice Address - Fax:510-970-5743
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00926199133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered