Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1275045932 |
---|---|
Provider Name | Armando Cervantes-Perez |
First Address | Tigard, OR 97223-6307 |
Second Address | Tigard, OR 97223-6307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2017 |
Last Update Date | 02/11/2017 |