1144323346 NPI number — DENISE STELLA BARBA BASILAN M.D.

Table of content: DENISE STELLA BARBA BASILAN M.D. (NPI 1144323346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144323346 NPI number — DENISE STELLA BARBA BASILAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BASILAN
Provider First Name:
DENISE STELLA
Provider Middle Name:
BARBA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BARBA
Provider Other First Name:
DENISE
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144323346
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4744 LIBERTY RD S
Provider Second Line Business Mailing Address:
# 120
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
971-599-1002
Provider Business Mailing Address Fax Number:
503-967-6107

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4744 LIBERTY RD S
Provider Second Line Business Practice Location Address:
#120
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
971-599-1002
Provider Business Practice Location Address Fax Number:
501-967-6107
Provider Enumeration Date:
09/06/2006

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: 207Q00000X , with the licence number:  MD189073 , 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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