Provider Demographics
NPI:1760027668
Name:DOHRN, EMMALINE
Entity Type:Individual
Prefix:
First Name:EMMALINE
Middle Name:
Last Name:DOHRN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14050 CHERRY AVE STE R122
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-0766
Mailing Address - Country:US
Mailing Address - Phone:909-355-8806
Mailing Address - Fax:
Practice Address - Street 1:1358 N NORTHSTAR AVE
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-6633
Practice Address - Country:US
Practice Address - Phone:928-846-0556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-14
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider