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1912648353
NIKITA S IVANOV
PORTLAND, OR
NPI
1912648353
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date
2022-04-06
Last Update Date
2023-04-19
Business Address
Dr. NIKITA S IVANOV MD
1015 NW 22ND AVE
PORTLAND, OR 97210-3025
Phone number: 503-413-8401
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Mailing Address
Dr. NIKITA S IVANOV MD
1015 NW 22ND AVE
PORTLAND, OR 97210-3025
Phone number: 503-200-8758
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