Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | 27 2407 | OR |
Y | 213ER0200X | Radiology | 27 2407 | OR |
NPI | 1356425177 |
---|---|
Provider Name | Dr. Edith Corinne Dal Mas |
First Address | Portland, OR 97214-4322 |
Second Address | Portland, OR 97214-4322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U50644 | (02) | OR |