Healthcare Provider Details

I. General information

NPI: 1184101255
Provider Name (Legal Business Name): DANA MICHELLE SURGICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 FULTON AVE STE 235
SACRAMENTO CA
95825-4299
US

IV. Provider business mailing address

PO BOX 691461
STOCKTON CA
95269-1461
US

V. Phone/Fax

Practice location:
  • Phone: 916-974-2599
  • Fax:
Mailing address:
  • Phone: 209-910-8125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number97151
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: