Active NPI
Raisa Michylovna Razloga, LMT
- Community Health Worker
- Salem, OR
National Provider Identifier
1891138665
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 12184
- Practice address
- 3530 Liberty Rd S
Salem, OR 97302-5622 - Phone
- (503) 856-5166
- Fax
- (503) 581-6102
- NPI assigned
- Apr 11, 2013
- 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 |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 12184 | OR | Primary |
Addresses
Primary practice location
3530 Liberty Rd S
Salem, OR 97302-5622
Mailing address
5206 Edgecrest CT SE
Salem, OR 97306-1840
Phone (503) 856-5166
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12184 | OR | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1365638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1365638400000",
"number": "1891138665",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5206 EDGECREST CT SE",
"city": "SALEM",
"state": "OR",
"postal_code": "973061840",
"telephone_number": "503-856-5166",
"fax_number": "503-581-6102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3530 LIBERTY RD S",
"city": "SALEM",
"state": "OR",
"postal_code": "973025622",
"telephone_number": "503-856-5166",
"fax_number": "503-581-6102"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAZLOGA",
"first_name": "RAISA",
"middle_name": "MICHYLOVNA",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-04-11",
"last_updated": "2013-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "OR",
"license": "12184",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.