Healthcare Provider Details

I. General information

NPI: 1740401116
Provider Name (Legal Business Name): PETER J. DORIAN, AUDIOLOGIST, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 08/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5180 N FRESNO ST SUITE 102
FRESNO CA
93710-6853
US

IV. Provider business mailing address

5180 N FRESNO ST SUITE 102
FRESNO CA
93710-6853
US

V. Phone/Fax

Practice location:
  • Phone: 559-224-1344
  • Fax: 559-224-3814
Mailing address:
  • Phone: 559-224-1344
  • Fax: 559-224-3814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU244
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberHA1194
License Number StateCA

VIII. Authorized Official

Name: MR. PETER JOHN DORIAN
Title or Position: PRESIDENT, OWNER
Credential: M.A.
Phone: 559-224-1344