Healthcare Provider Details

I. General information

NPI: 1205030111
Provider Name (Legal Business Name): DOREEN LANAE FUKUSHIMA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 W BULLARD AVE STE 104
CLOVIS CA
93612-0998
US

IV. Provider business mailing address

98-1813 HAPAKI ST
AIEA HI
96701-1633
US

V. Phone/Fax

Practice location:
  • Phone: 559-203-3775
  • Fax: 559-326-0607
Mailing address:
  • Phone: 209-629-7490
  • Fax: 351-200-8379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA124200
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMDR5045
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: