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1013097146
DERRICK EUGENE CUSTINO
HILLSBORO, OR
NPI
1013097146
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207Q00000X Family Medicine
(Licence: OR MD22041)
Enumeration Date
2006-10-16
Last Update Date
2022-02-04
Business Address
Dr. DERRICK EUGENE CUSTINO m.d.
19400 NW EVERGREEN PKWY
HILLSBORO, OR 97124-7031
Phone number: 503-645-2762
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Mailing Address
Dr. DERRICK EUGENE CUSTINO m.d.
19400 NW EVERGREEN PKWY
HILLSBORO, OR 97124-7031
Phone number: 503-645-2762
Copy
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