1427676352 NPI number — ALEXANDRA CS DIAMOND LMT, CST-T

Table of content: ALEXANDRA CS DIAMOND LMT, CST-T (NPI 1427676352)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427676352 NPI number — ALEXANDRA CS DIAMOND LMT, CST-T

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIAMOND
Provider First Name:
ALEXANDRA
Provider Middle Name:
CS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMT, CST-T
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:
1427676352
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4235 NE HOLMAN ST
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:
97218-1342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1832 NE BROADWAY ST # 2NW
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:
97232-1992
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-427-8110
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/07/2020

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: 225700000X , with the licence number:  25731 , 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)





Copyright © 2007-2025 www.npivalidator.com