Provider Demographics
NPI:1144431750
Name:MOODY, DAWNELL JEAN (DO)
Entity type:Individual
Prefix:DR
First Name:DAWNELL
Middle Name:JEAN
Last Name:MOODY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4361 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-6611
Mailing Address - Country:US
Mailing Address - Phone:925-462-1755
Mailing Address - Fax:925-462-1650
Practice Address - Street 1:5925 W LAS POSITAS BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-8537
Practice Address - Country:US
Practice Address - Phone:925-462-1755
Practice Address - Fax:925-417-1503
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10486208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics