Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath |
NPI | 1053962894 |
---|---|
Provider Name | Valentina Gordon Benitez |
First Address | Portland, OR 97239-4602 |
Second Address | Portland, OR 97201-4848 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2019 |
Last Update Date | 23/09/2019 |