Healthcare Provider Details

I. General information

NPI: 1447577630
Provider Name (Legal Business Name): NATASHA BAHM HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2010
Last Update Date: 04/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3108 PONTE MORINO DR STE 103
CAMERON PARK CA
95682-8278
US

IV. Provider business mailing address

10570 SE WAHINGTON ST STE 210
PORTLAND OR
97216
US

V. Phone/Fax

Practice location:
  • Phone: 530-676-3300
  • Fax:
Mailing address:
  • Phone: 503-257-6800
  • Fax: 503-257-6810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number7395
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: