Marshall Albert Canizalez, AUD | |
24076 Se Stark St Ste 230, Gresham, OR 97030-3385 | |
(503) 488-2600 | |
(503) 465-5468 |
Full Name | Marshall Albert Canizalez |
---|---|
Gender | Male |
Speciality | Audiologist |
Location | 24076 Se Stark St Ste 230, Gresham, Oregon |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1376205278 | NPI | - | NPPES |
500813168 | Medicaid | OR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
231H00000X | Audiologist | 147001852 (Illinois) | Secondary |
237600000X | Audiologist-hearing Aid Fitter | (* (Not Available)) | Secondary |
231H00000X | Audiologist | 31054 (Oregon) | Primary |
Provider Name | The Oregon Clinic, Pc |
---|---|
Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1265417174 PECOS PAC ID: 2860390408 Enrollment ID: O20031222000096 |
Provider Name | Kaiser Foundation Health Plan Of The Northwest |
---|---|
Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1184786527 PECOS PAC ID: 5799688230 Enrollment ID: O20040130000799 |
Mailing Address | Practice Location Address |
---|---|
Marshall Albert Canizalez, AUD 847 Ne 19th Ave Ste 300, Portland, OR 97232-2686 Ph: (503) 963-2801 | Marshall Albert Canizalez, AUD 24076 Se Stark St Ste 230, Gresham, OR 97030-3385 Ph: (503) 488-2600 |
Audiology And Hearing Aid Center Of Gresham Audiologist Medicare: Not Enrolled in Medicare Practice Location: 752 Ne Burnside St, Gresham, OR 97030 Phone: 503-669-7061 Fax: 503-492-3033 | |
Lottie Renee Rotterman, AUD Audiologist Medicare: Accepting Medicare Assignments Practice Location: 24076 Se Stark St, Suite 230, Gresham, OR 97030 Phone: 503-465-5461 Fax: 503-465-5468 |