1255680054 NPI number — NW NEUROPHYSIOLOGY CONSULTANTS

Table of content: ISAGANI DEGUZMAN VILLAROMAN PT (NPI 1609350289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255680054 NPI number — NW NEUROPHYSIOLOGY CONSULTANTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NW NEUROPHYSIOLOGY CONSULTANTS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1255680054
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7734 N FOWLER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97217-5931
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-724-9725
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7734 N FOWLER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97217-5931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-724-9725
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/07/2012

Additional Information

Authorized Official

Authorized Official Last Name:
DEMPSTER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
SOLE PROPRIETOR/OWNER
Authorized Official Telephone Number:
503-724-9725

Provider Taxonomy Codes

  • Taxonomy code: 2084N0600X , with the licence number:  MD60170989 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0600X , with the licence number: MD28304 , 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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