MEDICARE: MS. DAWN MARIE POLICH R.R.T

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	227900000X	Registered Respiratory Therapist	37197	CA

General Provider Information

NPI Number	:	1356708663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DAWN MARIE POLICH R.R.T

Provider Business Mailing Address
First Line	:	1919 FRUITDALE AVE. D15
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95128-4901
Country	:	US
Telephone Number	:	408-429-5683
Fax Number	:

Provider Business Practice Location Address
First Line	:	1919 FRUITDALE AVE APT D15
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95128-4901
Country	:	US
Telephone Number	:	408-429-5683
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2016
Last Update Date	:	01/19/2016

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