| San Rafael Kpoj | |
|
1620 Ne 122nd Ave Portland OR 97230-1913 | |
| (800) 813-2000 | |
| Not Available |
| Full Name | San Rafael Kpoj |
|---|---|
| Speciality | General Practice |
| Location | 1620 Ne 122nd Ave, Portland, Oregon |
| Authorized Official Name and Position | Stephen Shawn Barton (EXECUTIVE DIRECTOR, REVENUE CYCLE) |
| Authorized Official Contact | 5038132440 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| San Rafael Kpoj 500 Ne Multnomah St Portland OR 97232-2023 Ph: (800) 813-2000 | San Rafael Kpoj 1620 Ne 122nd Ave Portland OR 97230-1913 Ph: (800) 813-2000 |
| NPI Number | 1568130854 |
|---|---|
| Provider Enumeration Date | 09/01/2021 |
| Last Update Date | 10/01/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568130854 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| 261QX0100X | Clinic/center - Occupational Medicine | (* (Not Available)) | Secondary |
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