Healthcare Provider Details

I. General information

NPI: 1124784822
Provider Name (Legal Business Name): ANGELA DORFMAN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2021
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 N CAYMAN DR
GILBERT AZ
85234-2890
US

IV. Provider business mailing address

1208 N CAYMAN DR
GILBERT AZ
85234-2890
US

V. Phone/Fax

Practice location:
  • Phone: 602-628-9633
  • Fax:
Mailing address:
  • Phone: 602-628-9632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN206016
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number268958
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: