Provider Demographics
NPI:1528177482
Name:DOMANTAY, LAARNI NOCUM (MD)
Entity type:Individual
Prefix:
First Name:LAARNI
Middle Name:NOCUM
Last Name:DOMANTAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:191 S BUENA VISTA ST
Mailing Address - Street 2:SUITE 375
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4554
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
Practice Address - Street 2:SUITE 375
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4554
Practice Address - Country:US
Practice Address - Phone:818-729-0014
Practice Address - Fax:818-729-0019
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2009-02-20
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Provider Licenses
StateLicense IDTaxonomies
CAA73609207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH71345Medicare UPIN