Provider Demographics
NPI:1124162797
Name:DORNON, LYLE MATHUES (LCADC)
Entity type:Individual
Prefix:MR
First Name:LYLE
Middle Name:MATHUES
Last Name:DORNON
Suffix:
Gender:M
Credentials:LCADC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:471-450 JACOBS LN
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130-5010
Mailing Address - Country:US
Mailing Address - Phone:530-251-8112
Mailing Address - Fax:530-251-5884
Practice Address - Street 1:1410 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130-3719
Practice Address - Country:US
Practice Address - Phone:530-251-8112
Practice Address - Fax:530-251-5884
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV331174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist