Provider Demographics
NPI:1811136252
Name:DASHTBAN, GITTY KATIE (PSYD)
Entity type:Individual
Prefix:
First Name:GITTY
Middle Name:KATIE
Last Name:DASHTBAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 BAY AVE
Mailing Address - Street 2:STE 248
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2140
Mailing Address - Country:US
Mailing Address - Phone:831-621-1150
Mailing Address - Fax:
Practice Address - Street 1:820 BAY AVE
Practice Address - Street 2:STE 248
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2140
Practice Address - Country:US
Practice Address - Phone:831-621-1150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22256103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical