Individual
DAKOTA COOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
750 ORCHARD ROAD, DAVIS, CA 95616
(530) 752-1730
Mailing address
1900 BLUE OAKS BLVD APT 834, ROSEVILLE, CA 95747-8445
(541) 331-1987
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
CA
Other
Enumeration date
08/12/2019
Last updated
08/05/2020
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