Healthcare Provider Details

I. General information

NPI: 1376772616
Provider Name (Legal Business Name): NATASHIA MONIQUE MADRID HEIMBURGER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 NE 87TH AVE STE 160
VANCOUVER WA
98664-1965
US

IV. Provider business mailing address

2101 NE 139TH ST SUITE 350
VANCOUVER WA
98686-2309
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-1060
  • Fax:
Mailing address:
  • Phone: 360-256-4060
  • Fax: 360-256-0103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberOP60469079
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: