Individual
LAURA DIXON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
2227 PIEDMONT AVE, BERKELEY, CA 94720-2325
(510) 642-4878
Mailing address
1172 SARANAP AVE APT 7B, WALNUT CREEK, CA 94595-1133
(510) 367-9547
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
90002101
BOC CERTIFICATION
—
Enumeration date
05/13/2014
Last updated
05/13/2014
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