1336491356 NPI number — MRS. ROBIN WENDY FATAFEHI RDH, EPDH

Table of content: MRS. ROBIN WENDY FATAFEHI RDH, EPDH (NPI 1336491356)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336491356 NPI number — MRS. ROBIN WENDY FATAFEHI RDH, EPDH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FATAFEHI
Provider First Name:
ROBIN
Provider Middle Name:
WENDY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RDH, EPDH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROSS
Provider Other First Name:
ROBIN
Provider Other Middle Name:
WENDY
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RDH, EPDH
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336491356
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7014
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALOHA
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97007-7014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-440-2313
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20392 SW BLAINE CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALOHA
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97006-2115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-440-2313
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2012

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: 124Q00000X , with the licence number:  H6359 , 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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