1518574714 NPI number — MS. DUBRAVKA MARTINCIC DSHS MA4727, SA2595,

Table of content: MS. DUBRAVKA MARTINCIC DSHS MA4727, SA2595, (NPI 1518574714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518574714 NPI number — MS. DUBRAVKA MARTINCIC DSHS MA4727, SA2595,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTINCIC
Provider First Name:
DUBRAVKA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
DSHS MA4727, SA2595,
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:
1518574714
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1033 W 7TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99204-3007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-863-2548
Provider Business Mailing Address Fax Number:
509-339-7256

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1033 W 7TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99204-3007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-863-2548
Provider Business Practice Location Address Fax Number:
509-339-7256
Provider Enumeration Date:
09/30/2020

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: 171R00000X , 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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