| NPI | 1346574373 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LIZA DE LA CRUZ SAMSON Solo Practitioner 503-705-5753 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: OR MD22590) |
| Enumeration Date | 2009-09-23 |
| Last Update Date | 2012-09-12 |