Provider Demographics
NPI:1619250651
Name:SIBGATULLINA, RENATA (HAS)
Entity Type:Individual
Prefix:
First Name:RENATA
Middle Name:
Last Name:SIBGATULLINA
Suffix:
Gender:F
Credentials:HAS
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 350
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-0350
Mailing Address - Country:US
Mailing Address - Phone:425-358-0956
Mailing Address - Fax:877-481-6931
Practice Address - Street 1:11390 SE 82ND AVE
Practice Address - Street 2:STE. 801
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-7637
Practice Address - Country:US
Practice Address - Phone:503-653-5004
Practice Address - Fax:503-794-0531
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHAS-T-10141214237700000X
ORHAS-P-10139429237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist