Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | MD173369 | OR |
Y | 207YP0228X | Pediatric Otolaryngology | MD173369 | OR |
NPI | 1528293545 |
---|---|
Provider Name | Lourdes Quintanilla-Dieck |
First Address | Portland, OR 97239-3011 |
Second Address | Portland, OR 97239-3011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2009 |
Last Update Date | 27/04/2018 |