Basic Information
| Provider Information | |||||||||
| NPI: | 1063162584 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAUTERIVE | ||||||||
| FirstName: | ALISHIA | ||||||||
| MiddleName: | ANN-MARIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9012 SOQUEL DR APT 15 | ||||||||
| Address2: | |||||||||
| City: | APTOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950034042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314358622 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2001 THE ALAMEDA | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951261136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082617777 | ||||||||
| FaxNumber: | 4082592273 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2022 | ||||||||
| LastUpdateDate: | 03/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.