Provider Demographics
NPI:1669560629
Name:DAWSON, DIANE MARY (LM)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:MARY
Last Name:DAWSON
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:MARY
Other - Last Name:VANDERWESTHUIZEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:380 S EUCLID AVE
Mailing Address - Street 2:301
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-3178
Mailing Address - Country:US
Mailing Address - Phone:818-913-0448
Mailing Address - Fax:626-795-1680
Practice Address - Street 1:380 S EUCLID AVE
Practice Address - Street 2:301
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3178
Practice Address - Country:US
Practice Address - Phone:818-913-0448
Practice Address - Fax:626-795-1680
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA179176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife