Provider Demographics
NPI:1750859401
Name:LAARNI N. DOMANTAY, MD, INC
Entity Type:Organization
Organization Name:LAARNI N. DOMANTAY, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAARNI
Authorized Official - Middle Name:N
Authorized Official - Last Name:DOMANTAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-729-0014
Mailing Address - Street 1:191 S BUENA VISTA ST STE 375
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4558
Mailing Address - Country:US
Mailing Address - Phone:818-729-0014
Mailing Address - Fax:818-729-0019
Practice Address - Street 1:191 S BUENA VISTA ST STE 375
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4558
Practice Address - Country:US
Practice Address - Phone:818-729-0014
Practice Address - Fax:818-729-0019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty