Provider Demographics
NPI:1851676076
Name:GARRISON, DAWN (LAC)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:GARRISON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 HACIENDA DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-6637
Mailing Address - Country:US
Mailing Address - Phone:760-630-0683
Mailing Address - Fax:
Practice Address - Street 1:510 HACIENDA DR
Practice Address - Street 2:SUITE 107
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6637
Practice Address - Country:US
Practice Address - Phone:760-630-0683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14335171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist