Healthcare Provider Details

I. General information

NPI: 1619972510
Provider Name (Legal Business Name): ROBIN K DORE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 09/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12791 NEWPORT AVE SUITE 201
TUSTIN CA
92780-2751
US

IV. Provider business mailing address

12791 NEWPORT AVE SUITE 201
TUSTIN CA
92780-2751
US

V. Phone/Fax

Practice location:
  • Phone: 714-505-5500
  • Fax: 714-505-3381
Mailing address:
  • Phone: 714-505-5500
  • Fax: 714-505-3381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberG33113
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: