Basic Information
Provider Information
NPI: 1437323607
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROBLES NATEGHIAN
FirstName: MERCEDES
MiddleName: FARAH
NamePrefix: MS.
NameSuffix:  
Credential: OTR
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4560 SE INTERNATIONAL WAY SUITE 100
Address2: CONSONUS HEALTHCARE SERVICES
City: MILWAUKIE
State: OR
PostalCode: 97222
CountryCode: US
TelephoneNumber: 9712065149
FaxNumber: 9712065209
Practice Location
Address1: 4560 SE INTERNATIONAL WAY SUITE 100
Address2: CONSONUS HEALTHCARE SERVICES
City: MILWAUKIE
State: OR
PostalCode: 97222
CountryCode: US
TelephoneNumber: 9712065149
FaxNumber: 9712065209
Other Information
ProviderEnumerationDate: 04/17/2008
LastUpdateDate: 04/17/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X9892CAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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