Healthcare Provider Details

I. General information

NPI: 1609224369
Provider Name (Legal Business Name): ADLEY CHRIS DASON M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11234 ANDERSON ST LOMA LINDA UNIVERSITY HEALTH TRANSITIONAL YEAR
LOMA LINDA CA
92354-2804
US

IV. Provider business mailing address

11234 ANDERSON ST GME OFFICE WESTERLY SUITE C
LOMA LINDA CA
92354-2804
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-6491
  • Fax:
Mailing address:
  • Phone: 909-558-6491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberA153116
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberA153116
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: