Provider Demographics
NPI:1891150652
Name:AULD, DEIDRA (RRT)
Entity Type:Individual
Prefix:MISS
First Name:DEIDRA
Middle Name:
Last Name:AULD
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 TEAK GROVE CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-1761
Mailing Address - Country:US
Mailing Address - Phone:253-951-3528
Mailing Address - Fax:
Practice Address - Street 1:202 TEAK GROVE CT
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-1761
Practice Address - Country:US
Practice Address - Phone:253-951-3528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALR60475812227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA144519OtherNBRC
WALR60475812OtherWA STATE DEPARTMENT OF HEALTH