Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | D10672 | OR |
Y | 213EG0000X | General Practice | D10672 | OR |
NPI | 1003339375 |
---|---|
Provider Name | Dr. Paria Mazareei |
First Address | Clackamas, OR 97015-5334 |
Second Address | Portland, OR 97201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2017 |
Last Update Date | 12/08/2019 |