Healthcare Provider Details

I. General information

NPI: 1417228073
Provider Name (Legal Business Name): RICKI LEILA DOOLEY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 QUEBEC AVE
CORCORAN CA
93212-7100
US

IV. Provider business mailing address

1845 E BIRCH AVE APT 142
FRESNO CA
93720-3830
US

V. Phone/Fax

Practice location:
  • Phone: 559-992-7100
  • Fax:
Mailing address:
  • Phone: 559-472-3260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 24542
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: