Provider Demographics
NPI:1801029178
Name:REZANIA, DORNA (MD)
Entity Type:Individual
Prefix:
First Name:DORNA
Middle Name:
Last Name:REZANIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 RUTHERFORD RD
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-7328
Mailing Address - Country:US
Mailing Address - Phone:760-930-7142
Mailing Address - Fax:760-268-6201
Practice Address - Street 1:2110 RUTHERFORD RD
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-7328
Practice Address - Country:US
Practice Address - Phone:760-930-7142
Practice Address - Fax:760-268-6201
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 102979174400000X
CAA 102979207ZH0000X
FLME 95750207ZH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
No174400000XOther Service ProvidersSpecialist