Healthcare Provider Details

I. General information

NPI: 1104835396
Provider Name (Legal Business Name): PATTI JEAN DEWOSKIN L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15708 POMERADO RD SUITE 201
POWAY CA
92064-2066
US

IV. Provider business mailing address

15708 POMERADO RD SUITE 201
POWAY CA
92064-2066
US

V. Phone/Fax

Practice location:
  • Phone: 858-673-1559
  • Fax: 858-674-7419
Mailing address:
  • Phone: 858-673-1559
  • Fax: 858-674-7419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS7034
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: