Provider Demographics
NPI:1942990783
Name:TIH, DORIS (NURSE)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:
Last Name:TIH
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-0127
Mailing Address - Country:US
Mailing Address - Phone:310-940-2265
Mailing Address - Fax:
Practice Address - Street 1:12034 W POLK ST
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-7202
Practice Address - Country:US
Practice Address - Phone:310-940-2265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility