Provider Demographics
NPI:1316411671
Name:GORLA, DOINA (MBA-HM)
Entity Type:Individual
Prefix:
First Name:DOINA
Middle Name:
Last Name:GORLA
Suffix:
Gender:F
Credentials:MBA-HM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 W FLAMINGO AVE
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-1829
Mailing Address - Country:US
Mailing Address - Phone:208-922-8680
Mailing Address - Fax:208-936-3121
Practice Address - Street 1:1201 W FLAMINGO AVE
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-1829
Practice Address - Country:US
Practice Address - Phone:208-922-8680
Practice Address - Fax:208-936-3121
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDM8062488Medicaid