Healthcare Provider Details

I. General information

NPI: 1912747130
Provider Name (Legal Business Name): DORIS DJORGEE I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2024
Last Update Date: 05/27/2024
Certification Date: 05/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15600 REDMOND WAY
REDMOND WA
98052-3862
US

IV. Provider business mailing address

15600 REDMOND WAY
REDMOND WA
98052-3862
US

V. Phone/Fax

Practice location:
  • Phone: 425-242-0973
  • Fax:
Mailing address:
  • Phone: 206-308-7350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberCBT.CB.61093693
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: