Provider Demographics
NPI:1205882693
Name:DOUMANIAN, VALENTINA (MD)
Entity type:Individual
Prefix:
First Name:VALENTINA
Middle Name:
Last Name:DOUMANIAN
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 1:151 175TH AVE E
Mailing Address - Street 2:
Mailing Address - City:REDINGTON SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33708-1207
Mailing Address - Country:US
Mailing Address - Phone:515-779-6746
Mailing Address - Fax:512-838-4264
Practice Address - Street 1:3500 GASTON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2088
Practice Address - Country:US
Practice Address - Phone:214-820-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN634052084P0800X
ORMD1872792084P0800X
WAMD608392742084P0800X
MO20190105032084P0800X
IA365242084P0800X
WI86-3202084P0800X
TXR63842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0487256Medicaid
IA0487256Medicaid
IAI18037Medicare PIN