Basic Information
| Provider Information | |||||||||
| NPI: | 1508879115 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DORFF | ||||||||
| FirstName: | TANYA | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 512185 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900510185 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267753514 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1500 DUARTE RD | ||||||||
| Address2: | |||||||||
| City: | DUARTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910103012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262564673 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2006 | ||||||||
| LastUpdateDate: | 12/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | A82669 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207R00000X | A82669 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RX0202X | A82669 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | GR0100430 | 01 | CA | GROUP MEDICAL | OTHER | A82669 | 01 | CA | MEDICAL LICENSE | OTHER | W15185A | 01 | CA | MEDICARE PTAN - FACILITY | OTHER | W15185 | 01 | CA | MEDICARE PTAN - FACILITY | OTHER | W18762 | 01 | CA | GROUP MEDICARE | OTHER | 1902846306 | 01 | CA | GROUP NPI | OTHER | BD8355124 | 01 | CA | DEA | OTHER |