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General NPI Number Information
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NPI Number | 1538601737
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Entity Type | Organization
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Legal Business Name | DIANA S DOMNITEI MD LLC
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Dates
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Enumeration Date | 11/06/2016
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Last Update Date | 11/06/2016
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Provider Practice Location Address
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Address Line | 1012 SW KING AVE STE 306
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City | PORTLAND
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State | OR
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Zip | 97205-1110
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Country | US
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Telephone | 503-467-8763
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Fax |
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Provider Business Mailing Address
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Address Line | 1012 SW KING AVE STE 306
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City | PORTLAND
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State | OR
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Zip | 97205-1110
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DIANA SIDONIA DOMNITEI
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Credential | MD
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Telephone | 503-467-8763
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD155672
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License Number State | OR
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