Provider Demographics
NPI:1447676408
Name:DAW, LLC
Entity type:Organization
Organization Name:DAW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WEYMOUTH
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:209-481-0091
Mailing Address - Street 1:4583 PINE VALLEY CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-1871
Mailing Address - Country:US
Mailing Address - Phone:209-333-1148
Mailing Address - Fax:209-333-0624
Practice Address - Street 1:1745 W KETTLEMAN LN
Practice Address - Street 2:STE. A
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-9287
Practice Address - Country:US
Practice Address - Phone:209-481-0091
Practice Address - Fax:209-333-0624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACP01776224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty