Provider Demographics
NPI:1417604281
Name:CAGATIN-PORTER, NOEMI
Entity Type:Individual
Prefix:
First Name:NOEMI
Middle Name:
Last Name:CAGATIN-PORTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2367 TACOMA AVE S # 215
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-1409
Mailing Address - Country:US
Mailing Address - Phone:253-507-3576
Mailing Address - Fax:
Practice Address - Street 1:5306 N 47TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-3816
Practice Address - Country:US
Practice Address - Phone:253-507-3576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health