Active NPI
Lisa A Fargo, LMT
- Specialist
- Beaverton, OR
National Provider Identifier
1699874081
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 11230
- Practice address
- 3800 SW Cedar Hills Blvd
#203
Beaverton, OR 97005-2027 - Phone
- (971) 645-2257
- NPI assigned
- Sep 21, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 11230 | OR | Primary |
Addresses
Primary practice location
3800 SW Cedar Hills Blvd
#203
Beaverton, OR 97005-2027
Mailing address
13165 SW Essex Dr
Tigard, OR 97223-5646
Phone (971) 645-2257
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Theology
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11230 | OR | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1699874081",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13165 SW ESSEX DR",
"city": "TIGARD",
"state": "OR",
"postal_code": "972235646",
"telephone_number": "971-645-2257"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3800 SW CEDAR HILLS BLVD",
"address_2": "#203",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970052027",
"telephone_number": "971-645-2257"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FARGO",
"first_name": "LISA",
"middle_name": "A",
"name_prefix": "Mrs.",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "OR",
"license": "11230",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beaverton, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.