Jeanette Dibala, SA-C

Key facts

NPI

1699127993

Entity type

Individual (NPI type 1)

Primary specialty

Surgical Assistant 246ZC0007X

License

16-379 (OR)

Practice address

342 Fairview St
Silverton, OR 97381-1917

Phone

(503) 873-1713

NPI assigned

Jul 11, 2016

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 11, 2016.

{
    "created_epoch": "1468195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468195200000",
    "number": "1699127993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12353 SILVERTON RD NE",
            "city": "SILVERTON",
            "state": "OR",
            "postal_code": "973819363",
            "telephone_number": "503-428-4983",
            "fax_number": "503-873-1707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "342 FAIRVIEW ST",
            "city": "SILVERTON",
            "state": "OR",
            "postal_code": "973811917",
            "telephone_number": "503-873-1713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIBALA",
        "first_name": "JEANETTE",
        "credential": "SA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-07-11",
        "last_updated": "2016-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "OR",
            "license": "16-379",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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