Basic Information
| Provider Information | |||||||||
| NPI: | 1497936645 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOROFTEI | ||||||||
| FirstName: | OLGA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1701 W NORTHWEST HWY STE 100 | ||||||||
| Address2: | |||||||||
| City: | GRAPEVINE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760518145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172849850 | ||||||||
| FaxNumber: | 8172843425 | ||||||||
| Practice Location | |||||||||
| Address1: | 1701 W NORTHWEST HWY STE 100 | ||||||||
| Address2: | |||||||||
| City: | GRAPEVINE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172849850 | ||||||||
| FaxNumber: | 8172843425 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2007 | ||||||||
| LastUpdateDate: | 06/04/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 2007012257 | MO | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | N6265 | TX | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 2171258-02 | 05 | TX | MEDICAID | 8CU423 | 01 | TX | BCBS | OTHER |