Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0205X | Pediatric Endocrinologist | 04-34256 | KS |
Y | 2080P0205X | Pediatric Endocrinologist | MD179939 | OR |
NPI | 1245430933 |
---|---|
Provider Name | Angela Elaine Santiago Lennon |
First Address | Portland, OR 97208-3158 |
Second Address | Portland, OR 97225-6652 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2007 |
Last Update Date | 15/02/2021 |