Provider Demographics
NPI:1497803894
Name:DONAYRE, DORENE KAY (NP)
Entity Type:Individual
Prefix:MS
First Name:DORENE
Middle Name:KAY
Last Name:DONAYRE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 BAYWATER AVE
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-6673
Mailing Address - Country:US
Mailing Address - Phone:310-612-0041
Mailing Address - Fax:949-266-3750
Practice Address - Street 1:4019 WESTERLY PL
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2317
Practice Address - Country:US
Practice Address - Phone:949-266-3700
Practice Address - Fax:949-266-3750
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA346273163W00000X
CANP 12557363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health