Healthcare Provider Details

I. General information

NPI: 1487567483
Provider Name (Legal Business Name): DORFRA K VASSILATOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15031 RINALDI ST
MISSION HILLS CA
91345-1207
US

IV. Provider business mailing address

17710 LASSEN ST APT 309
NORTHRIDGE CA
91325-4745
US

V. Phone/Fax

Practice location:
  • Phone: 818-857-8530
  • Fax:
Mailing address:
  • Phone: 818-857-8530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95041341
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: