Provider Demographics
NPI:1467007336
Name:DORT, CARRIE L (RN)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:L
Last Name:DORT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23700 CAMINO DEL SOL
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5000
Mailing Address - Country:US
Mailing Address - Phone:310-530-1151
Mailing Address - Fax:310-784-2233
Practice Address - Street 1:23700 CAMINO DEL SOL
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5000
Practice Address - Country:US
Practice Address - Phone:310-530-1151
Practice Address - Fax:310-784-2233
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95085037163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health