Healthcare Provider Details

I. General information

NPI: 1962433219
Provider Name (Legal Business Name): JOI DENISE DAWSON A.T.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W IMPERIAL HWY
LOS ANGELES CA
90047-4810
US

IV. Provider business mailing address

3923 DEGNAN BLVD
LOS ANGELES CA
90008-2615
US

V. Phone/Fax

Practice location:
  • Phone: 323-241-5379
  • Fax:
Mailing address:
  • Phone: 323-295-0563
  • Fax: 323-241-5350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: