Provider Demographics
NPI:1982687851
Name:DAWES, LISA ANNE (RD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE
Last Name:DAWES
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 WEST BUNNY AVENUE
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-2805
Mailing Address - Country:US
Mailing Address - Phone:805-597-6715
Mailing Address - Fax:805-597-6716
Practice Address - Street 1:1941 JOHNSON AVENUE
Practice Address - Street 2:SUITE 301
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4175
Practice Address - Country:US
Practice Address - Phone:805-597-6715
Practice Address - Fax:805-597-6716
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2015-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA883324133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGB179ZOtherMEDICARE ID
P50363Medicare UPIN
WNT883324AMedicare PIN