Healthcare Provider Details

I. General information

NPI: 1750859401
Provider Name (Legal Business Name): LAARNI N. DOMANTAY, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2018
Last Update Date: 11/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 S BUENA VISTA ST STE 375
BURBANK CA
91505-4558
US

IV. Provider business mailing address

191 S BUENA VISTA ST STE 375
BURBANK CA
91505-4558
US

V. Phone/Fax

Practice location:
  • Phone: 818-729-0014
  • Fax: 818-729-0019
Mailing address:
  • Phone: 818-729-0014
  • Fax: 818-729-0019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LAARNI N DOMANTAY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-729-0014