Basic Information
| Provider Information | |||||||||
| NPI: | 1871165050 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAWSON | ||||||||
| FirstName: | DORIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 514839 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900512839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3235700445 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8220 S SAN PEDRO ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900033030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3235700445 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2021 | ||||||||
| LastUpdateDate: | 07/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 126664 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1508206848 | 05 | CA | MEDICAID |