1174864102 NPI number — DR. MEGAN CHRISTINE CORMIER CASTANEDA PSYD

Table of content: DR. MEGAN CHRISTINE CORMIER CASTANEDA PSYD (NPI 1174864102)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174864102 NPI number — DR. MEGAN CHRISTINE CORMIER CASTANEDA PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORMIER CASTANEDA
Provider First Name:
MEGAN
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174864102
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14535 WESTLAKE DR STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE OSWEGO
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97035-7775
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-832-4857
Provider Business Mailing Address Fax Number:
503-386-3413

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7340 SW HUNZIKER RD STE 210
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TIGARD
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97223-2304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-352-0036
Provider Business Practice Location Address Fax Number:
503-352-0040
Provider Enumeration Date:
03/15/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: 3277 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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