Healthcare Provider Details

I. General information

NPI: 1821260233
Provider Name (Legal Business Name): VIRGINIA R DORAME LICENSED PSYCH.TECH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 N HUDSON AVE
PASADENA CA
91101-1808
US

IV. Provider business mailing address

1609 ADALIA AVE
HACIENDA HEIGHTS CA
91745-3221
US

V. Phone/Fax

Practice location:
  • Phone: 626-795-8471
  • Fax: 626-449-4925
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT29801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: