Healthcare Provider Details

I. General information

NPI: 1790448900
Provider Name (Legal Business Name): DORA MARIA PELLETIER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2021
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 HERNDON AVE STE 101
CLOVIS CA
93611-6316
US

IV. Provider business mailing address

2021 HERNDON AVE STE 101
CLOVIS CA
93611-6316
US

V. Phone/Fax

Practice location:
  • Phone: 559-797-4315
  • Fax: 559-677-4715
Mailing address:
  • Phone: 559-797-4315
  • Fax: 559-677-4715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number202538
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: