Healthcare Provider Details

I. General information

NPI: 1508594318
Provider Name (Legal Business Name): ANGELIQUE DORE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HILLMONT AVE
VENTURA CA
93003-1651
US

IV. Provider business mailing address

615 E HARVARD BLVD APT 201
SANTA PAULA CA
93060-3871
US

V. Phone/Fax

Practice location:
  • Phone: 805-652-6218
  • Fax:
Mailing address:
  • Phone: 805-758-8122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number95054175
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95021089
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: