Healthcare Provider Details

I. General information

NPI: 1104058072
Provider Name (Legal Business Name): DORA ANNA RENDULIC STORELLI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DORA ANNA RENDULIC MD

II. Dates (important events)

Enumeration Date: 08/11/2009
Last Update Date: 01/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 PARNASSUS AVE # MU320-W
SAN FRANCISCO CA
94143-2203
US

IV. Provider business mailing address

5050 NE HOYT ST STE 340
PORTLAND OR
97213-2983
US

V. Phone/Fax

Practice location:
  • Phone: 415-514-3288
  • Fax:
Mailing address:
  • Phone: 503-467-7090
  • Fax: 503-546-7240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberMD182410
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: