Provider Demographics
NPI:1497189328
Name:SECAIRA, RAMON OBDULIO I (TFP)
Entity Type:Individual
Prefix:MR
First Name:RAMON
Middle Name:OBDULIO
Last Name:SECAIRA
Suffix:I
Gender:M
Credentials:TFP
Other - Prefix:MRS
Other - First Name:TRINIDAD
Other - Middle Name:
Other - Last Name:SECAIRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1501 NE JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-3647
Mailing Address - Country:US
Mailing Address - Phone:971-241-0105
Mailing Address - Fax:
Practice Address - Street 1:1501 NE JOHNSON ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-3647
Practice Address - Country:US
Practice Address - Phone:971-241-0105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5736928103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst