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1356658512
ANTONIA LARISSA GRAGG
PORTLAND, OR
NPI
1356658512
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Former Name
ANTONIA LARISSA SOINEY
Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: OR PA153285)
Enumeration Date
2010-09-09
Last Update Date
2013-07-05
Business Address
Mrs. ANTONIA LARISSA GRAGG PA-C
3303 SW BOND AVE CH8N
PORTLAND, OR 97239-4501
Phone number: 503-494-4314
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Mailing Address
Mrs. ANTONIA LARISSA GRAGG PA-C
3303 SW BOND AVE CH8N
PORTLAND, OR 97239-4501
Phone number: 503-494-4314
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