Provider Demographics
NPI:1144450354
Name:ZITOMER, DOLORES (RN, MSM, FNP, WCC)
Entity type:Individual
Prefix:MS
First Name:DOLORES
Middle Name:
Last Name:ZITOMER
Suffix:
Gender:F
Credentials:RN, MSM, FNP, WCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 S LA REINA WAY
Mailing Address - Street 2:3 A
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-8659
Mailing Address - Country:US
Mailing Address - Phone:760-323-3165
Mailing Address - Fax:
Practice Address - Street 1:36923 COOK ST
Practice Address - Street 2:SUITE 103
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-6073
Practice Address - Country:US
Practice Address - Phone:760-636-1336
Practice Address - Fax:760-636-1335
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA508836363LF0000X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA508836OtherBRN CALIFORNIA RN
CA19134OtherBRN NP