Healthcare Provider Details

I. General information

NPI: 1497936645
Provider Name (Legal Business Name): OLGA DOROFTEI M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 W NORTHWEST HWY STE 100
GRAPEVINE TX
76051
US

IV. Provider business mailing address

1701 W NORTHWEST HWY STE 100
GRAPEVINE TX
76051-8145
US

V. Phone/Fax

Practice location:
  • Phone: 817-284-9850
  • Fax: 817-284-3425
Mailing address:
  • Phone: 817-284-9850
  • Fax: 817-284-3425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2007012257
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberN6265
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: