Basic Information
| Provider Information | |||||||||
| NPI: | 1578807442 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | UY | ||||||||
| FirstName: | RAFAELANI | ||||||||
| MiddleName: | TARUC | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1718 E KESSLER BLVD | ||||||||
| Address2: | |||||||||
| City: | LONGVIEW | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986321842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607475849 | ||||||||
| FaxNumber: | 3605753846 | ||||||||
| Practice Location | |||||||||
| Address1: | 1718 E KESSLER BLVD | ||||||||
| Address2: | |||||||||
| City: | LONGVIEW | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986321842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607475849 | ||||||||
| FaxNumber: | 3605753846 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2012 | ||||||||
| LastUpdateDate: | 02/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 125059208 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD60439195 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.