Provider Demographics
NPI:1912185505
Name:CLINIQUE DE LA VICTOIRE DONABEDIAN PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:CLINIQUE DE LA VICTOIRE DONABEDIAN PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARAL
Authorized Official - Middle Name:
Authorized Official - Last Name:DONABEDIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-617-4399
Mailing Address - Street 1:10925 SOUTHERN HIGHLANDS PKWY
Mailing Address - Street 2:APT 2065
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-4302
Mailing Address - Country:US
Mailing Address - Phone:702-617-4399
Mailing Address - Fax:
Practice Address - Street 1:10925 SOUTHERN HIGHLANDS PKWY
Practice Address - Street 2:APT 2065
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141-4302
Practice Address - Country:US
Practice Address - Phone:702-617-4399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10818207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty