Provider Demographics
NPI:1750680252
Name:DOREZA, CHARLENE G (NP)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:G
Last Name:DOREZA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:450 E HUNTINGTON DR STE 202
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3748
Mailing Address - Country:US
Mailing Address - Phone:626-943-7211
Mailing Address - Fax:626-943-7212
Practice Address - Street 1:450 E HUNTINGTON DR STE 202
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3748
Practice Address - Country:US
Practice Address - Phone:626-943-7211
Practice Address - Fax:626-943-7212
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA19372363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner