Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | MD27733 | OR |
NPI | 1033206594 |
---|---|
Provider Name | Dr. Cristian R. Vallejos |
First Address | Portland, OR 97232-2684 |
Second Address | Portland, OR 97225-6772 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 01/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
241789 | (05) | OR |
2502569 | (05) | WA |
I53719 | (02) | OR |