Provider Demographics
NPI:1235442203
Name:LIANA HATEGAN MD PC
Entity Type:Organization
Organization Name:LIANA HATEGAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LIANA
Authorized Official - Middle Name:F
Authorized Official - Last Name:HATEGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:971-228-8672
Mailing Address - Street 1:3370 SW 192ND AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97003-2346
Mailing Address - Country:US
Mailing Address - Phone:971-228-8672
Mailing Address - Fax:971-228-8673
Practice Address - Street 1:3370 SW 192ND AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97003-2346
Practice Address - Country:US
Practice Address - Phone:971-228-8672
Practice Address - Fax:971-228-8673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-20
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)