DUSTIN GARRETT FORTADO (NPI# 1538662614) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538662614 |
| Entity Type | Individual |
| Full Name | DUSTIN GARRETT FORTADO |
| Credential | CRM |
| Practice Address |
1025 E Main St Medford OR 97504-7448 |
| Mailing Address |
1003 E Main St Ste 104 Medford OR 97504-7140 |
| Practice Telephone | 5417791282 |
| Mailing Telephone | 5417791282 |
| Enumeration Date | 2018-03-14 |
| Last Update Date | 2018-03-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175T00000X | Peer Specialist | Other Service Providers |
| Street Address |
1025 E MAIN ST |
| City | MEDFORD |
| State | OR |
| Zip Code | 97504-7448 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639712375 | Jennifer Jurhee Arnold | Counselor | 1025 E Main St, Medford, OR 97504-7689 | 2019-10-25 |
| 1750923827 | Tina Lyn Fain | Peer Specialist | 1025 E Main St, Medford, OR 97504-7689 | 2019-10-10 |
| 1043873946 | Carrie Jo Oliver | Peer Specialist | 1025 E Main St, Medford, OR 97504-7448 | 2019-04-16 |
| 1063970937 | Benjamin R Spence | Peer Specialist | 1025 E Main St, Medford, OR 97504-7448 | 2019-03-08 |
| 1306301478 | Caryn A Mclane | Peer Specialist | 1025 E Main St, Medford, OR 97504-7448 | 2019-02-04 |
| 1679054142 | Tiffany A Atkinson | Peer Specialist | 1025 E Main St, Medford, OR 97504-7448 | 2018-08-23 |
| 1578049474 | Alexandria R Davis | Peer Specialist | 1025 E Main St, Medford, OR 97504-7448 | 2018-07-13 |
| 1407359599 | Stephen Dale Sleezer | Counselor | 1025 E Main St, Medford, OR 97504-7448 | 2018-03-14 |
| 1689186546 | Julie A Conley-rucker | Peer Specialist | 1025 E Main St, Medford, OR 97504-7448 | 2017-11-01 |
| 1265889018 | Holly S Holcomb | Counselor | 1025 E Main St, Medford, OR 97504 | 2016-05-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225673833 | Lydia D Sneed | Behavioral Analyst | 3707 Citation Way, Suite 102, Medford, OR 97504 | 2019-11-07 |
| 1114577368 | Heather Ashley Fronek | Nurse Practitioner | 2825 E. Barnett Rd., Medford, OR 97504 | 2019-09-18 |
| 1255809109 | Justin Blasdel | Technician, Health Information | 3250 Lone Pine Rd, Medford, OR 97504 | 2018-11-08 |
| 1396220133 | Aimee K Michel | Massage Therapist | 3550 National Dr., Medford, OR 97504 | 2018-09-27 |
| 1437646908 | Zola Dental Medford LLC | Dentist | 922 E Main, Medford, OR 97504 | 2018-04-19 |
| 1376068015 | Megan Leggett | Counselor | 777 Murphy Road, Medford, OR 97504 | 2017-08-03 |
| 1023547536 | Joshua Morgan Rice | Dentist | 1117 E Main St Ste 1, Medford, OR 97504 | 2017-06-08 |
| 1427580232 | Paul James Dean | Counselor | 1175 Main St Ste 1c, Medford, OR 97504 | 2017-03-30 |
| 1811443542 | Taya Adams | Doula | 1201 Progress Dr #90, Medford, OR 97504 | 2016-09-01 |
| 1174076228 | Avalon Health Care - Hearthstone, LLC | Skilled Nursing Facility | 2091 E. Barnett Road, Medford, OR 97504 | 2016-07-25 |
| Find all providers in zip 97504 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265073282 | Brandon Wade Orr | Peer Specialist | 611 W 11th St Apt 2, Medford, OR 97501-3572 | 2019-10-01 |
| 1558829358 | Robert Crawford | Peer Specialist | 221 W Main St # B13, Medford, OR 97501-2728 | 2019-03-11 |
| 1063977858 | Hayley Jo Burns | Peer Specialist | 1362 Garfield St, Medford, OR 97501-3979 | 2019-02-05 |
| 1972962355 | Robin Clevenger | Peer Specialist | 301 S Ivy St, Medford, OR 97501 | 2016-02-15 |
| 1902288871 | Kelly Burrows | Peer Specialist | 817 N Central Ave, Suite C, Medford, OR 97501-5840 | 2015-06-26 |
| 1396351730 | Dana Alexzandria Bogdanove | Peer Specialist | 140 S Holly St, Medford, OR 97501-3113 | 2020-09-21 |
| 1609493873 | Heather Marie Getz | Peer Specialist | 200 Beatty St, Medford, OR 97501-5811 | 2020-07-02 |
| 1508483405 | Justin Karl Sacco | Peer Specialist | 140 S Holly St, Medford, OR 97501-3113 | 2020-06-26 |
| 1275156564 | Mayela Villa | Peer Specialist | 140 S Holly St, Medford, OR 97501-3113 | 2020-05-21 |
| 1427686021 | Richard Joseph Mccleary | Peer Specialist | 200 Beatty St, Medford, OR 97501-5811 | 2020-03-30 |
| Find all providers in MEDFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.