Healthcare Provider Details

I. General information

NPI: 1881321917
Provider Name (Legal Business Name): MIGUEL DORTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4605 ROAD 68
PASCO WA
99301-9366
US

IV. Provider business mailing address

4605 ROAD 68
PASCO WA
99301-9366
US

V. Phone/Fax

Practice location:
  • Phone: 509-567-6450
  • Fax:
Mailing address:
  • Phone: 509-567-6450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMDCE.ML.70116274
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: