Provider Demographics
NPI:1245566553
Name:GARFIAS, WANDA PAULA FAYE (LMT)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:PAULA FAYE
Last Name:GARFIAS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16092
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97292-0092
Mailing Address - Country:US
Mailing Address - Phone:503-754-2830
Mailing Address - Fax:
Practice Address - Street 1:1441 SE 122ND AVE STE A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-1271
Practice Address - Country:US
Practice Address - Phone:503-754-2830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14774172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker