1669053484 NPI number — MRS. PILAR ADELINA PANGKASANK MASSAGE THERAPIST

Table of content: MRS. PILAR ADELINA PANGKASANK MASSAGE THERAPIST (NPI 1669053484)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669053484 NPI number — MRS. PILAR ADELINA PANGKASANK MASSAGE THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PANGKASANK
Provider First Name:
PILAR
Provider Middle Name:
ADELINA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MASSAGE THERAPIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PANGKASANK
Provider Other First Name:
PILAR
Provider Other Middle Name:
ADELINA
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MASSAGE THERAPIST
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1669053484
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
405 N.E. DIVISION ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRESHAM
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-661-0791
Provider Business Mailing Address Fax Number:
503-661-1136

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 N.E. DIVISION ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRESHAM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-661-0791
Provider Business Practice Location Address Fax Number:
503-661-1136
Provider Enumeration Date:
04/15/2021

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: 225700000X , with the licence number:  25962 , 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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