1871767103 NPI number — MRS. GILDA MONICA BURLACU MOT, OTR/L

Table of content: MRS. GILDA MONICA BURLACU MOT, OTR/L (NPI 1871767103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871767103 NPI number — MRS. GILDA MONICA BURLACU MOT, OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURLACU
Provider First Name:
GILDA
Provider Middle Name:
MONICA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MOT, OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VEJA
Provider Other First Name:
GILDA
Provider Other Middle Name:
MONICA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MOT, OTR/L
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871767103
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4201 NE 66TH AVE
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98661
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-885-4684
Provider Business Mailing Address Fax Number:
360-882-8972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4201 NE 66TH AVE
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-885-4684
Provider Business Practice Location Address Fax Number:
360-882-8972
Provider Enumeration Date:
04/17/2008

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: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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