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General NPI Number Information
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NPI Number | 1184101255
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Entity Type | Individual
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Provider Name | DANA MICHELLE SURGICK
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Gender | Female
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Dates
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Enumeration Date | 07/23/2018
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 1050 FULTON AVE STE 235
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City | SACRAMENTO
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State | CA
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Zip | 95825-4299
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Country | US
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Telephone | 916-974-2599
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 691461
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City | STOCKTON
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State | CA
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Zip | 95269-1461
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Country | US
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Telephone | 209-910-8125
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 97151
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License Number State | CA
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