Provider Demographics
NPI:1417779851
Name:SO FIYA LLC
Entity type:Organization
Organization Name:SO FIYA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SELIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AVAKEMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-732-5090
Mailing Address - Street 1:2512 N FREMONT LOOP
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:OR
Mailing Address - Zip Code:97113-1039
Mailing Address - Country:US
Mailing Address - Phone:818-732-5090
Mailing Address - Fax:
Practice Address - Street 1:21195 NW WEST UNION RD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-8543
Practice Address - Country:US
Practice Address - Phone:971-205-2216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-28
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty