Healthcare Provider Details

I. General information

NPI: 1487260311
Provider Name (Legal Business Name): DORIA LIVING PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 3RD ST W BLDG 1040
JBSA RANDOLPH TX
78150-4800
US

IV. Provider business mailing address

221 3RD ST W BLDG 1040
JBSA RANDOLPH TX
78150-4800
US

V. Phone/Fax

Practice location:
  • Phone: 210-652-8544
  • Fax:
Mailing address:
  • Phone: 210-652-8544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1636008
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1636008
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number199069
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: