1437285319 NPI number — ANGELINA RAMOS-MARCHAND PSYD

Table of content: ANGELINA RAMOS-MARCHAND PSYD (NPI 1437285319)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437285319 NPI number — ANGELINA RAMOS-MARCHAND PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAMOS-MARCHAND
Provider First Name:
ANGELINA
Provider Middle Name:
Provider Name Prefix Text:
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:
MARCHAND
Provider Other First Name:
ANGELINA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSYD, LLC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1437285319
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 13101
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:
97213-0101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-528-8404
Provider Business Mailing Address Fax Number:
503-528-8405

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
516 SE MORRISON ST
Provider Second Line Business Practice Location Address:
SUITE 705
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97214-2327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-367-9687
Provider Business Practice Location Address Fax Number:
503-528-8405
Provider Enumeration Date:
02/26/2007

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: 103TC0700X , with the licence number:  1693 , 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)

  • Identifier: 875045000 . This is a "REGENCE BCBS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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