Provider Demographics
NPI:1184430027
Name:DORF, GARY (AUD DROF AUDIOLOGY)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:DORF
Suffix:
Gender:M
Credentials:AUD DROF AUDIOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3735 BLUE KY
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-1203
Mailing Address - Country:US
Mailing Address - Phone:949-632-8223
Mailing Address - Fax:
Practice Address - Street 1:260 NEWPORT CENTER DR STE 415
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7520
Practice Address - Country:US
Practice Address - Phone:949-478-1254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA538237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter