Provider Demographics
NPI:1487420121
Name:DAWN, ASHLEY (LEC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:DAWN
Suffix:
Gender:F
Credentials:LEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3403 42ND ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-4107
Mailing Address - Country:US
Mailing Address - Phone:619-241-1608
Mailing Address - Fax:
Practice Address - Street 1:3403 42ND ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-4107
Practice Address - Country:US
Practice Address - Phone:619-241-1608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist