Healthcare Provider Details

I. General information

NPI: 1205882693
Provider Name (Legal Business Name): VALENTINA DOUMANIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 GASTON AVE
DALLAS TX
75246-2088
US

IV. Provider business mailing address

151 175TH AVE E
REDINGTON SHORES FL
33708-1207
US

V. Phone/Fax

Practice location:
  • Phone: 214-820-0111
  • Fax:
Mailing address:
  • Phone: 515-779-6746
  • Fax: 512-838-4264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number63405
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD187279
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD60839274
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2019010503
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number36524
License Number StateIA
# 6
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number86-320
License Number StateWI
# 7
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR6384
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: