1699798199 NPI number — NICOLE HARRINGTON CIRINO MD

Table of content: NICOLE HARRINGTON CIRINO MD (NPI 1699798199)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699798199 NPI number — NICOLE HARRINGTON CIRINO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CIRINO
Provider First Name:
NICOLE
Provider Middle Name:
HARRINGTON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1699798199
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3181 SW SAM JACKSON PARK RD
Provider Second Line Business Mailing Address:
L587 STUDENT HEALTH SERVICE
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-494-8665
Provider Business Mailing Address Fax Number:
503-494-9099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6651 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030-2351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-826-7376
Provider Business Practice Location Address Fax Number:
832-825-7948
Provider Enumeration Date:
07/25/2006

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: 2084P0800X , with the licence number:  U26702 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 054123029 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: J930728 . This is a "PACIFIC SOURCE" identifier . This identifiers is of the category "OTHER".




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