Provider Demographics
NPI:1801176300
Name:BROBISKY, MARIKA ELIZABETH
Entity type:Individual
Prefix:MRS
First Name:MARIKA
Middle Name:ELIZABETH
Last Name:BROBISKY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MARIKA
Other - Middle Name:ELIZABETH
Other - Last Name:BELEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:MAIL CODE L102
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-4662
Mailing Address - Fax:503-494-8120
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:MAIL CODE L102
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-4662
Practice Address - Fax:503-494-8120
Is Sole Proprietor?:No
Enumeration Date:2011-08-28
Last Update Date:2011-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program