1376640631 NPI number — MS. REBECCA CHANGIZIAN CST SAC

Table of content: MS. REBECCA CHANGIZIAN CST SAC (NPI 1376640631)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376640631 NPI number — MS. REBECCA CHANGIZIAN CST SAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHANGIZIAN
Provider First Name:
REBECCA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CST SAC
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:
1376640631
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5319 SW WESTGATE DR
Provider Second Line Business Mailing Address:
SUITE 241
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97221-2432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-297-7223
Provider Business Mailing Address Fax Number:
503-297-7603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11782 SW BARNES RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-906-4300
Provider Business Practice Location Address Fax Number:
503-906-4333
Provider Enumeration Date:
09/20/2006

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: 246ZS0410X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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