Provider Demographics
NPI:1750691721
Name:JAWAHIR, DYLAN QUINN (LAC, LMT)
Entity type:Individual
Prefix:MR
First Name:DYLAN
Middle Name:QUINN
Last Name:JAWAHIR
Suffix:
Gender:M
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10910 POLARIS DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-2446
Mailing Address - Country:US
Mailing Address - Phone:858-349-5057
Mailing Address - Fax:
Practice Address - Street 1:11848 BERNARDO PLAZA CT
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2416
Practice Address - Country:US
Practice Address - Phone:858-349-5057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13828171100000X
225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist