Provider Demographics
NPI:1073859369
Name:FELINA, REX BAZAR
Entity Type:Individual
Prefix:MR
First Name:REX
Middle Name:BAZAR
Last Name:FELINA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14318 SE STARK ST APT 3
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-2172
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14318 SE STARK ST
Practice Address - Street 2:APT. 3
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-2172
Practice Address - Country:US
Practice Address - Phone:503-957-3493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17471174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist