Healthcare Provider Details

I. General information

NPI: 1184285439
Provider Name (Legal Business Name): ESTELA C DORN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ESTELA G CRUZ

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 05/08/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72926 FRED WARING DR STE 22
PALM DESERT CA
92260
US

IV. Provider business mailing address

72960 FRED WARING DR STE 22
PALM DESERT CA
92260-2897
US

V. Phone/Fax

Practice location:
  • Phone: 760-404-0360
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95011850
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: