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1114564630
MITALIBEN RAJENDRAKUMAR GOR
COOS BAY, OR
NPI
1114564630
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: OR 201909528NP-PP)
Enumeration Date
2019-12-03
Last Update Date
2019-12-03
Business Address
MITALIBEN RAJENDRAKUMAR GOR NP
1900 WOODLAND DR
COOS BAY, OR 97420-2099
Phone number: 541-267-5151
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Mailing Address
MITALIBEN RAJENDRAKUMAR GOR NP
705 EDWARDS AVE
COOS BAY, OR 97420-3408
Phone number: 541-404-1414
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