Healthcare Provider Details

I. General information

NPI: 1689591992
Provider Name (Legal Business Name): THERESA DORRIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7811 218TH ST SW
EDMONDS WA
98026-7945
US

IV. Provider business mailing address

881 NORSE LN
ESCONDIDO CA
92025-6344
US

V. Phone/Fax

Practice location:
  • Phone: 760-877-9489
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: