Provider Demographics
NPI:1639361868
Name:DOMNITEI, DIANA (MD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:DOMNITEI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 SW SAINT CLAIR AVE STE 2C
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1300
Mailing Address - Country:US
Mailing Address - Phone:503-816-2045
Mailing Address - Fax:503-265-8194
Practice Address - Street 1:909 SW SAINT CLAIR AVE STE 2C
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-1300
Practice Address - Country:US
Practice Address - Phone:503-816-2045
Practice Address - Fax:503-265-8194
Is Sole Proprietor?:No
Enumeration Date:2007-08-12
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1556722084P0800X
NE56982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry