Provider Demographics
NPI:1255917399
Name:FAGOAGA, ISABEL (LMT)
Entity type:Individual
Prefix:
First Name:ISABEL
Middle Name:
Last Name:FAGOAGA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 NE SHERWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-4130
Mailing Address - Country:US
Mailing Address - Phone:760-216-3507
Mailing Address - Fax:
Practice Address - Street 1:650 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4437
Practice Address - Country:US
Practice Address - Phone:760-216-3507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist