| NPI | 1659956589 |
|---|---|
| Other Name | NES PORTLAND NW LOVEJOY |
| Entity Type | Organization |
| Authorized Contact | THOMAS CHARLES MELILLO Owner 503-245-2420 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QP1100X Clinic/Center, Podiatric |
| Enumeration Date | 2021-03-11 |
| Last Update Date | 2021-03-11 |