Healthcare Provider Details

I. General information

NPI: 1801029178
Provider Name (Legal Business Name): DORNA REZANIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 EASTSHORE HWY
BERKELEY CA
94710-1703
US

IV. Provider business mailing address

1725 EASTSHORE HWY
BERKELEY CA
94710-1703
US

V. Phone/Fax

Practice location:
  • Phone: 510-559-5116
  • Fax:
Mailing address:
  • Phone: 510-898-4269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA 102979
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberME 95750
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberA 102979
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: