=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992076160
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAWN KRISTEN BORTOLUZZI D.C., B.SC.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2012
-----------------------------------------------------
Last Update Date | 01/19/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9340 CLAIREMONT MESA BLVD STE E
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92123-1224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-279-1012
-----------------------------------------------------
Fax | 858-279-1011
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3927 NOBEL DR UNIT 60
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92122-5716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-660-0095
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 32150
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------