Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | MD00020447 | WA |
NPI | 1023049244 |
---|---|
Provider Name | Dr. Evan Miller Cantini |
First Address | Portland, OR 97208-3360 |
Second Address | Everett, WA 98201-1684 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 01/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G8919022 | (02) | WA |