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1184246704
VICTOR COLLAZO VIDALES
PORTLAND, OR
NPI
1184246704
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date
2020-05-18
Last Update Date
2020-05-18
Business Address
VICTOR COLLAZO VIDALES
2730 S MOODY AVE
PORTLAND, OR 97201-5042
Phone number: 503-494-0843
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Mailing Address
VICTOR COLLAZO VIDALES
2730 S MOODY AVE
PORTLAND, OR 97201-5042
Phone number:
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