Healthcare Provider Details

I. General information

NPI: 1043398233
Provider Name (Legal Business Name): NICHOLAS JAMES DOGRIS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 W LINE ST STE 204
BISHOP CA
93514-3320
US

IV. Provider business mailing address

PO BOX 426
BISHOP CA
93515-0426
US

V. Phone/Fax

Practice location:
  • Phone: 760-872-9153
  • Fax: 760-873-8007
Mailing address:
  • Phone: 760-872-9153
  • Fax: 760-873-8007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPSY 17334
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: