Deborah

Specialty details in registry · Portland, OR

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At a glance

5517 N Commercial Ave, Portland, OR 97217-2339

NPPES record updated Jun 6, 2012. Public records can lag behind changes at a practice.

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Insurance participation and appointment availability are not established by these public records.

Practice location

5517 N Commercial Ave
Portland, OR 97217-2339

Professional details: NPI, taxonomy & registry record

NPI1154682128

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Registry details

Primary taxonomy: Specialty details in registry
Taxonomy code: 171100000X
Enumeration date: Jun 6, 2012
Record updated: Jun 6, 2012

More registry details

Provider type: Organization · Type 2

Reported taxonomies and licenses

Specialty details in registry

171100000X · Primary

License reported: AC00879 OR

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

5517 N Commercial Ave
Portland, OR 97217-2339

Phone: (503) 891-8569

Mailing address

5517 N COMMERCIAL AVE

PORTLAND, OR 972172339

Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

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