Healthcare Provider Details

I. General information

NPI: 1639594088
Provider Name (Legal Business Name): RAKIYA DAWSON LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2014
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 UNIVERSITY AVE # 2B
RIVERSIDE CA
92507-5355
US

IV. Provider business mailing address

1820 UNIVERSITY AVE STE 2B
RIVERSIDE CA
92507-5355
US

V. Phone/Fax

Practice location:
  • Phone: 419-514-4222
  • Fax:
Mailing address:
  • Phone:
  • Fax: 951-955-9840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95360680
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN 214748
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: