1760132328 NPI number — MRS. CRISTINA BOGUNA FALCO QMHP

Table of content: MRS. CRISTINA BOGUNA FALCO QMHP (NPI 1760132328)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760132328 NPI number — MRS. CRISTINA BOGUNA FALCO QMHP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOGUNA FALCO
Provider First Name:
CRISTINA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
QMHP
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:
1760132328
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
161 HIGH ST SE
Provider Second Line Business Mailing Address:
STE 232
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-757-8068
Provider Business Mailing Address Fax Number:
541-758-1030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
161 HIGH ST SE
Provider Second Line Business Practice Location Address:
STE 232
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-818-0009
Provider Business Practice Location Address Fax Number:
541-758-1030
Provider Enumeration Date:
03/26/2022

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: R8399 , 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)

  • Identifier: 128715 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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