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General NPI Number Information
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NPI Number | 1265875967
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Entity Type | Individual
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Provider Name | CHARLES ROBERT DAWES CMT
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Gender | Male
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Dates
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Enumeration Date | 04/11/2013
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Last Update Date | 04/11/2013
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Provider Practice Location Address
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Address Line | 1 LARKSPUR PLAZA DR
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City | LARKSPUR
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State | CA
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Zip | 94939-1471
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Country | US
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Telephone | 415-924-6226
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Fax |
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Provider Business Mailing Address
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Address Line | 34 1/2 WILLOW AVE
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City | FAIRFAX
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State | CA
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Zip | 94930-8001
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Country | US
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Telephone | 415-879-1240
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 19799
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License Number State | CA
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