Healthcare Provider Details

I. General information

NPI: 1356708663
Provider Name (Legal Business Name): DAWN MARIE POLICH R.R.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2016
Last Update Date: 01/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 FRUITDALE AVE APT D15
SAN JOSE CA
95128-4901
US

IV. Provider business mailing address

1919 FRUITDALE AVE. D15
SAN JOSE CA
95128-4901
US

V. Phone/Fax

Practice location:
  • Phone: 408-429-5683
  • Fax:
Mailing address:
  • Phone: 408-429-5683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number37197
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: