1184704371 NPI number — PAIGE RAFFO MPT

Table of content: PAIGE RAFFO MPT (NPI 1184704371)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184704371 NPI number — PAIGE RAFFO MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAFFO
Provider First Name:
PAIGE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MPT
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:
1184704371
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13033 NE 102ND PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KIRKLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98033-5246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-794-3835
Provider Business Mailing Address Fax Number:
805-794-3835

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2820 NORTHUP WAY
Provider Second Line Business Practice Location Address:
SUITE 245
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98004-1419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-794-3835
Provider Business Practice Location Address Fax Number:
805-794-3835
Provider Enumeration Date:
10/16/2006

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: 2251X0800X , with the licence number:  PT28451 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251X0800X , with the licence number: PT 60134281 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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