Provider Demographics
NPI:1306020953
Name:DORENZO, THERESA ANN (RN/PHN)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:ANN
Last Name:DORENZO
Suffix:
Gender:F
Credentials:RN/PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 TABLE MOUNTAIN BLVD
Mailing Address - Street 2:SUITE 20
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965-3578
Mailing Address - Country:US
Mailing Address - Phone:530-538-7008
Mailing Address - Fax:530-538-5279
Practice Address - Street 1:82 TABLE MOUNTAIN BLVD
Practice Address - Street 2:SUITE 20
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-3578
Practice Address - Country:US
Practice Address - Phone:530-538-7008
Practice Address - Fax:530-538-5279
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2963942083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine