Provider Demographics
NPI:1073970828
Name:VANG, PAJYEEBSUAB (COTA)
Entity Type:Individual
Prefix:
First Name:PAJYEEBSUAB
Middle Name:
Last Name:VANG
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 GEORGE WASHINGTON WAY
Mailing Address - Street 2:APT B
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354-2343
Mailing Address - Country:US
Mailing Address - Phone:509-318-5548
Mailing Address - Fax:
Practice Address - Street 1:1914 GEORGE WASHINGTON WAY
Practice Address - Street 2:APT B
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354-2343
Practice Address - Country:US
Practice Address - Phone:509-318-5548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC60451655171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor