Provider Demographics
NPI:1700189693
Name:DOROTHY E HAIRSTON M D A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DOROTHY E HAIRSTON M D A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:E
Authorized Official - Last Name:HAIRSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-472-4690
Mailing Address - Street 1:10531 4S COMMONS DR # 144
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-3517
Mailing Address - Country:US
Mailing Address - Phone:646-526-5142
Mailing Address - Fax:
Practice Address - Street 1:10531 4S COMMONS DR # 144
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-3517
Practice Address - Country:US
Practice Address - Phone:646-526-5142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78226207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty