Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 31472 | CA |
NPI | 1124358361 |
---|---|
Provider Name | Dr. Andrea Baiotto Dorris |
First Address | San Diego, CA 92120-2300 |
Second Address | San Diego, CA 92120-2300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2010 |
Last Update Date | 19/04/2018 |