Healthcare Provider Details

I. General information

NPI: 1932105723
Provider Name (Legal Business Name): LAURIE DORNBRAND M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ON LOK SENIOR HEALTH - INSTITUTE ON AGING
SAN FRANCISCO CA
94155-0001
US

IV. Provider business mailing address

103 PLAZA DR
BERKELEY CA
94705-2415
US

V. Phone/Fax

Practice location:
  • Phone: 415-447-1000
  • Fax: 415-447-1035
Mailing address:
  • Phone: 510-547-7950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberG33377
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: