Healthcare Provider Details

I. General information

NPI: 1548398472
Provider Name (Legal Business Name): DAWN NICOLI DADES M.F.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 S 2ND AVE
COVINA CA
91723-3012
US

IV. Provider business mailing address

985 KENDALL DR UNIT 283
SAN BERNARDINO CA
92407-4315
US

V. Phone/Fax

Practice location:
  • Phone: 626-974-8122
  • Fax: 626-974-8198
Mailing address:
  • Phone: 626-974-1822
  • Fax: 626-974-8198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC29487
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: