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1245065366
SHANE ANTHONY GONZALES
PORTLAND, OR
NPI
1245065366
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder
Enumeration Date
2024-09-06
Last Update Date
2024-09-06
Business Address
SHANE ANTHONY GONZALES C.R.M.
1122 NE 122ND AVE STE A200
PORTLAND, OR 97230-2083
Phone number: 503-594-4774
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Mailing Address
SHANE ANTHONY GONZALES C.R.M.
1122 NE 122ND AVE STE A200
PORTLAND, OR 97230-2083
Phone number: 503-594-4774
Copy
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