Provider Demographics
NPI:1306599345
Name:EMANUEL, DORIEN (PSYD)
Entity type:Individual
Prefix:DR
First Name:DORIEN
Middle Name:
Last Name:EMANUEL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:DORIEN
Other - Middle Name:
Other - Last Name:EMANUEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DORIEN EMANUEL
Mailing Address - Street 1:12423 ANTELOPE DR
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-7916
Mailing Address - Country:US
Mailing Address - Phone:760-403-7397
Mailing Address - Fax:
Practice Address - Street 1:12423 ANTELOPE DR
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-7916
Practice Address - Country:US
Practice Address - Phone:760-403-7397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program