Provider Demographics
NPI:1114001674
Name:MOTYKA, DAWN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:
Last Name:MOTYKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 MISSION ST STE 5
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-3559
Mailing Address - Country:US
Mailing Address - Phone:831-421-0197
Mailing Address - Fax:888-449-2472
Practice Address - Street 1:930 MISSION ST STE 5
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3559
Practice Address - Country:US
Practice Address - Phone:831-421-0197
Practice Address - Fax:888-449-2472
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63571207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E78689Medicare UPIN
ZZZ72284ZMedicare ID - Type Unspecified