1407919350 NPI number — JASMINE PATEL MSAOM, LAC

Table of content: JASMINE PATEL MSAOM, LAC (NPI 1407919350)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407919350 NPI number — JASMINE PATEL MSAOM, LAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
JASMINE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSAOM, LAC
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:
1407919350
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9735 SW SHADY LN
Provider Second Line Business Mailing Address:
SUITE 306
Provider Business Mailing Address City Name:
TIGARD
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97223-5481
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-573-4239
Provider Business Mailing Address Fax Number:
503-573-4241

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9735 SW SHADY LN
Provider Second Line Business Practice Location Address:
SUITE 306
Provider Business Practice Location Address City Name:
TIGARD
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97223-5481
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-573-4239
Provider Business Practice Location Address Fax Number:
503-573-4241
Provider Enumeration Date:
12/19/2006

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: 171100000X , with the licence number:  0965 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 171100000X , with the licence number: 00002104 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 00002104 . This is a "ACUPUNCTURE LICENSE NUMBE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0965 . This is a "ACUPUNCTURE LICENSE NUMBE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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