Provider Demographics
NPI:1356708663
Name:POLICH, DAWN MARIE (RRT)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:MARIE
Last Name:POLICH
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 1:1919 FRUITDALE AVE. D15
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4901
Mailing Address - Country:US
Mailing Address - Phone:408-429-5683
Mailing Address - Fax:
Practice Address - Street 1:1919 FRUITDALE AVE APT D15
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4901
Practice Address - Country:US
Practice Address - Phone:408-429-5683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37197227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered