Provider Demographics
NPI:1992076160
Name:BORTOLUZZI, DAWN KRISTEN (DC, BSC)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:KRISTEN
Last Name:BORTOLUZZI
Suffix:
Gender:F
Credentials:DC, BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3927 NOBEL DR UNIT 60
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-5716
Mailing Address - Country:US
Mailing Address - Phone:408-660-0095
Mailing Address - Fax:
Practice Address - Street 1:9340 CLAIREMONT MESA BLVD STE E
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1224
Practice Address - Country:US
Practice Address - Phone:858-279-1012
Practice Address - Fax:858-279-1011
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32150111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor