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511 Sw 10th Ave Ste 904 Portland OR 97205-2710 | |
(503) 221-1870 | |
(503) 389-7945 |
Full Name | |
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Speciality | Clinic/center |
Location | 511 Sw 10th Ave Ste 904, Portland, Oregon |
Authorized Official Name and Position | Nadya Volkoff (MANAGER) |
Authorized Official Contact | 5038840842 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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511 Sw 10th Ave Ste 904 Portland OR 97205-2710 Ph: (503) 221-1870 | 511 Sw 10th Ave Ste 904 Portland OR 97205-2710 Ph: (503) 221-1870 |
NPI Number | 1760076392 |
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Provider Enumeration Date | 02/24/2021 |
Last Update Date | 07/01/2021 |
Identifier | Type | State | Issuer |
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1760076392 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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