Provider Demographics
NPI:1457909244
Name:DOGAR, TAIMOORE (PHCY TECH)
Entity type:Individual
Prefix:
First Name:TAIMOORE
Middle Name:
Last Name:DOGAR
Suffix:
Gender:M
Credentials:PHCY TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16231 MOUNT LOWE CIR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-2135
Mailing Address - Country:US
Mailing Address - Phone:714-299-6049
Mailing Address - Fax:
Practice Address - Street 1:800 N TUSTIN AVE STE K
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3605
Practice Address - Country:US
Practice Address - Phone:714-558-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATCH171300183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician