MEDICARE: DAWN HEALTH OF CALIFORNIA, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	103T00000X	Psychologist

General Provider Information

NPI Number	:	1093412165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAWN HEALTH OF CALIFORNIA, P.C.

Provider Business Mailing Address
First Line	:	315 MONTGOMERY ST FL 10
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94104-1823
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 MONTGOMERY ST FL 10
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94104-1823
Country	:	US
Telephone Number	:	408-768-9596
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RAFID FADUL
Credential	:	M.D.
Telephone Number	:	408-768-9596

Provider Enumeration Date	:	02/09/2023
Last Update Date	:	02/09/2023

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