Provider Demographics
NPI:1043852726
Name:MARGARITO, ALEX (ATC)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:MARGARITO
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17340 SW JAY ST APT 202
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97003-7651
Mailing Address - Country:US
Mailing Address - Phone:408-219-4791
Mailing Address - Fax:
Practice Address - Street 1:6801 NECORNFOOT RD
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AA
Practice Address - Zip Code:97218
Practice Address - Country:US
Practice Address - Phone:503-335-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAT-AT-101611062255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORAT-AT-10161106Medicaid