Organization
DIANA S DOMNITEI MD LLC
Active
Organization
DIANA S DOMNITEI MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANA SIDONIA DOMNITEI MD (MEMBER)
(503) 467-8763
Entity
Organization
Contact information
Practice address
1012 SW KING AVE STE 306, PORTLAND, OR 97205-1110
(503) 467-8763
Mailing address
1012 SW KING AVE STE 306, PORTLAND, OR 97205-1110
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD155672
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1639361868
INDIVIDUAL NPI
OR
Enumeration date
11/06/2016
Last updated
11/06/2016
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