Graduated: 2016
NPI: 1780131532
Practice Locations (3)
PROVIDENCE HEALTH AND SERVICES OREGON
1321 NE 99TH AVE, SUITE 200
PORTLAND, OR 972209439
5032154250
PROVIDENCE HEALTH AND SERVICES OREGON
4805 NE GLISAN ST
PORTLAND, OR 972132933
PROVIDENCE HEALTH AND SERVICES OREGON
5050 NE HOYT ST
PORTLAND, OR 972132985
Source: CMS National Downloadable File, September 2026.