Provider Demographics
NPI:1649705930
Name:DONAY, OMEED M (PA-C)
Entity type:Individual
Prefix:
First Name:OMEED
Middle Name:M
Last Name:DONAY
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 WILSHIRE BLVD # 212
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4602
Mailing Address - Country:US
Mailing Address - Phone:310-481-3288
Mailing Address - Fax:
Practice Address - Street 1:10400 WILSHIRE BLVD # 212
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4602
Practice Address - Country:US
Practice Address - Phone:310-481-3288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-25
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54983363A00000X
CA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty