Provider Demographics
NPI:1750706214
Name:TOTPAL, DONELITA
Entity type:Individual
Prefix:
First Name:DONELITA
Middle Name:
Last Name:TOTPAL
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 1:10350 SW AVERY ST
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-9516
Mailing Address - Country:US
Mailing Address - Phone:503-486-5644
Mailing Address - Fax:503-427-1144
Practice Address - Street 1:10350 SW AVERY ST
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9516
Practice Address - Country:US
Practice Address - Phone:503-486-5644
Practice Address - Fax:503-427-1144
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR522659376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator