Healthcare Provider Details

I. General information

NPI: 1144450354
Provider Name (Legal Business Name): DOLORES ZITOMER RN, MSM, FNP, WCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 11/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36923 COOK ST SUITE 103
PALM DESERT CA
92211-6073
US

IV. Provider business mailing address

1660 S LA REINA WAY 3 A
PALM SPRINGS CA
92264-8659
US

V. Phone/Fax

Practice location:
  • Phone: 760-636-1336
  • Fax: 760-636-1335
Mailing address:
  • Phone: 760-323-3165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number508836
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number508836
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: