Healthcare Provider Details

I. General information

NPI: 1104936152
Provider Name (Legal Business Name): DOROTHY KOWALSKI B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 CAMINO DEL RIO S SUITE NUMBER 305
SAN DIEGO CA
92108-3608
US

IV. Provider business mailing address

5083 VOLTAIRE ST
SAN DIEGO CA
92107-2024
US

V. Phone/Fax

Practice location:
  • Phone: 619-279-1971
  • Fax:
Mailing address:
  • Phone: 619-851-9079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: