Provider Demographics
NPI:1871364869
Name:DORSAINVILLE, RAISA
Entity type:Individual
Prefix:
First Name:RAISA
Middle Name:
Last Name:DORSAINVILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8717 N 39TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-2409
Mailing Address - Country:US
Mailing Address - Phone:845-825-6671
Mailing Address - Fax:
Practice Address - Street 1:2120 RANGE RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-2125
Practice Address - Country:US
Practice Address - Phone:727-437-7771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171400000XOther Service ProvidersHealth & Wellness Coach