Healthcare Provider Details

I. General information

NPI: 1568012060
Provider Name (Legal Business Name): EMMA DORN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2019
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 S QUINTANA DR
ANAHEIM CA
92807-4029
US

IV. Provider business mailing address

16384 FELICE DR
SAN DIEGO CA
92128-3004
US

V. Phone/Fax

Practice location:
  • Phone: 714-202-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: