Healthcare Provider Details

I. General information

NPI: 1285212654
Provider Name (Legal Business Name): EMILY DORIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 W CHARLESTON BLVD STE 142
LAS VEGAS NV
89146-1050
US

IV. Provider business mailing address

11695 HATCHLING AVE
LAS VEGAS NV
89138-6449
US

V. Phone/Fax

Practice location:
  • Phone: 702-440-8430
  • Fax:
Mailing address:
  • Phone: 619-379-2252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDO3853
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: