Healthcare Provider Details

I. General information

NPI: 1871616045
Provider Name (Legal Business Name): DAWN RACHELE HARTSOCK PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 CONSTITUTION BLVD, BLDG 300
SALINAS CA
93912
US

IV. Provider business mailing address

8650 DYER RD
PRUNEDALE CA
93907
US

V. Phone/Fax

Practice location:
  • Phone: 831-796-1624
  • Fax: 831-751-3067
Mailing address:
  • Phone: 831-663-6206
  • Fax: 831-663-6206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA12691
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: