Provider Demographics
NPI:1598071615
Name:BABAKOVA, ALESIA L (LMT)
Entity type:Individual
Prefix:
First Name:ALESIA
Middle Name:L
Last Name:BABAKOVA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17223 SE DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-1240
Mailing Address - Country:US
Mailing Address - Phone:503-760-0778
Mailing Address - Fax:
Practice Address - Street 1:12014 SE MILL PLAIN BLVD
Practice Address - Street 2:S120
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-4043
Practice Address - Country:US
Practice Address - Phone:360-891-0199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16263174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist