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Individual

MICHAEL ALAN DONATH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
604 ROSE AVE, VENICE, CA 90291-2767
(310) 392-8636
(310) 943-3521
Mailing address
604 ROSE AVE, VENICE, CA 90291-2767
(310) 392-8636
(310) 943-3521

Taxonomy

Speciality
Code
Description
License number
State
2084P0015X
Psychosomatic Medicine Physician
Primary
A177661
CA
2084P0800X
Psychiatry Physician
A177661
CA
2084P0800X
Psychiatry Physician
PTL644
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
390200000X
39 STUDENT,HEALTH CARE
CA
05
A177661
CA
Enumeration date
10/15/2017
Last updated
09/17/2024
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