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General NPI Number Information
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NPI Number | 1639368590
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Entity Type | Individual
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Provider Name | MANYA DIANE DOBAJ PMHNP
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Gender | Female
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Dates
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Enumeration Date | 10/17/2007
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Last Update Date | 03/21/2022
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Provider Practice Location Address
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Address Line | 10315 NE TANASBOURNE DR
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City | HILLSBORO
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State | OR
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Zip | 97124-7836
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Country | US
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Telephone | 503-249-3434
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Fax | 503-495-8523
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Provider Business Mailing Address
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Address Line | 10315 NE TANASBOURNE DR
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City | HILLSBORO
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State | OR
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Zip | 97124-7836
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Country | US
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Telephone | 503-249-3434
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Fax | 34-958-5235
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP60021577
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 20050091NP
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License Number State | OR
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