Organization
NW OLIVE CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SABAH TARGHI N.D. (OWNER)
(360) 258-0627
Entity
Organization
Contact information
Practice address
302 E 37TH ST, VANCOUVER, WA 98663-2212
(360) 258-0627
Mailing address
302 E 37TH ST, VANCOUVER, WA 98663-2212
(360) 258-0627
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
NT60548368
WA
Other
Enumeration date
12/02/2015
Last updated
12/02/2015
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