Provider Demographics
NPI:1740401116
Name:PETER J. DORIAN, AUDIOLOGIST, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:PETER J. DORIAN, AUDIOLOGIST, A PROFESSIONAL CORPORATION
Other - Org Name:DORIAN HEARING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:DORIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:559-224-1344
Mailing Address - Street 1:5180 N FRESNO ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-6853
Mailing Address - Country:US
Mailing Address - Phone:559-224-1344
Mailing Address - Fax:559-224-3814
Practice Address - Street 1:5180 N FRESNO ST
Practice Address - Street 2:SUITE 102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-6853
Practice Address - Country:US
Practice Address - Phone:559-224-1344
Practice Address - Fax:559-224-3814
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PETER J. DORIAN, AUDIOLOGIST, A PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-01
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU244231H00000X
CAHA1194237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR22235OtherUPIN
CACGP120700OtherCCS-MADERA COUNTY
CAZZZ96583ZOtherRAILROAD MEDI-CARE
CA5251815OtherMEDI-CAL
CA7.33.18Medicaid
CAZZZ75041ZMedicaid
CA9802919OtherCCS-MADERA COUNTY
CAZZZ75041ZOtherMEDI-CAL
CAZZZ75041ZOtherMEDI-CAL
CAZZZ75041ZMedicare PIN