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1154963437
MICAH DESHAZO
PORTLAND, OR
NPI
1154963437
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
171M00000X Case Manager/Care Coordinator
Enumeration Date
2019-10-08
Last Update Date
2019-10-08
Business Address
MICAH DESHAZO
14600 NW CORNELL RD
PORTLAND, OR 97229-5442
Phone number: 503-555-5555
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Mailing Address
MICAH DESHAZO
14600 NW CORNELL RD
PORTLAND, OR 97229-5442
Phone number:
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