Provider Demographics
NPI:1831484294
Name:DORANTES, MIGUEL ANGEL (MD)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ANGEL
Last Name:DORANTES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9460 NO NAME UNO
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020
Mailing Address - Country:US
Mailing Address - Phone:408-729-4290
Mailing Address - Fax:
Practice Address - Street 1:9460 N NAME UNO
Practice Address - Street 2:SUITE 110
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-3537
Practice Address - Country:US
Practice Address - Phone:408-729-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA128733207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA551869Medicare PIN