Graduated: 2009
NPI: 1053607457
Practice Locations (4)
PROVIDENCE HEALTH AND SERVICES OREGON
1321 NE 99TH AVE, SUITE 200
PORTLAND, OR 972209439
5032154250
LEGACY CLINICS LLC
19300 SW 65TH AVE, MERIDIAN PARK HOSP
PORTLAND, OR 970627706
5036921212
PROVIDENCE HEALTH AND SERVICES OREGON
5050 NE HOYT ST, SUITE 240
PORTLAND, OR 972132981
5032156480
PROVIDENCE HEALTH AND SERVICES OREGON
9205 SW BARNES RD
PORTLAND, OR 972256603
Source: CMS National Downloadable File, September 2026.