Provider Demographics
NPI:1356813489
Name:DAUGHERTY, PAULA (RRT-NPS)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:RRT-NPS
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:DEEAN
Other - Last Name:COWAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RRT-NPS
Mailing Address - Street 1:851 COACHMAN PL
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:CA
Mailing Address - Zip Code:94517-1526
Mailing Address - Country:US
Mailing Address - Phone:409-939-5274
Mailing Address - Fax:
Practice Address - Street 1:275 W MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5641
Practice Address - Country:US
Practice Address - Phone:510-752-5212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-31
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38657227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered