Healthcare Provider Details

I. General information

NPI: 1689705436
Provider Name (Legal Business Name): MS. THERESA MAUREEN DAUSCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 01/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18302 IRVINE BLVD SUITE 300
TUSTIN CA
92780-3435
US

IV. Provider business mailing address

615 E BROADWAY #406
LONG BEACH CA
90802-5113
US

V. Phone/Fax

Practice location:
  • Phone: 714-881-8671
  • Fax: 714-957-1065
Mailing address:
  • Phone: 310-968-6126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberIMF48060
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMFC 49031
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: