Healthcare Provider Details

I. General information

NPI: 1457795130
Provider Name (Legal Business Name): NICHOLAS J. DOGRIS, PH.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2013
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536 W LINE ST STE A
BISHOP CA
93514-3313
US

IV. Provider business mailing address

PO BOX 426
BISHOP CA
93515-0426
US

V. Phone/Fax

Practice location:
  • Phone: 760-872-9153
  • Fax:
Mailing address:
  • Phone: 760-872-9153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPSY 17334
License Number StateCA

VIII. Authorized Official

Name: NICHOLAS JAMES DOGRIS
Title or Position: PSYCHOLOGIST PRESIDENT
Credential: PH.D.
Phone: 760-872-9153