Healthcare Provider Details

I. General information

NPI: 1467007336
Provider Name (Legal Business Name): CARRIE L DORT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2019
Last Update Date: 08/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23700 CAMINO DEL SOL
TORRANCE CA
90505-5000
US

IV. Provider business mailing address

23700 CAMINO DEL SOL
TORRANCE CA
90505-5000
US

V. Phone/Fax

Practice location:
  • Phone: 310-530-1151
  • Fax: 310-784-2233
Mailing address:
  • Phone: 310-530-1151
  • Fax: 310-784-2233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95085037
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: