Healthcare Provider Details

I. General information

NPI: 1952750655
Provider Name (Legal Business Name): MARIA DORADO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 N FAIR OAKS AVE
PASADENA CA
91103-1620
US

IV. Provider business mailing address

432 W 2ND ST
SAN DIMAS CA
91773-2030
US

V. Phone/Fax

Practice location:
  • Phone: 626-398-6300
  • Fax: 626-398-5948
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number606437
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: