Healthcare Provider Details

I. General information

NPI: 1942530027
Provider Name (Legal Business Name): VAFA TALEBI RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 01/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33611 NE 60TH AVE
LA CENTER WA
98629-2723
US

IV. Provider business mailing address

33611 NE 60TH AVE
LA CENTER WA
98629-2723
US

V. Phone/Fax

Practice location:
  • Phone: 503-810-3368
  • Fax:
Mailing address:
  • Phone: 503-810-3368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number099000646RN RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: