Healthcare Provider Details

I. General information

NPI: 1942990783
Provider Name (Legal Business Name): DORIS TIH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 N BULLARD AVE
GOODYEAR AZ
85395-2743
US

IV. Provider business mailing address

PO BOX 127
LITCHFIELD PARK AZ
85340-0127
US

V. Phone/Fax

Practice location:
  • Phone: 310-940-2265
  • Fax:
Mailing address:
  • Phone: 310-940-2265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number234432
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: