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Organization
WILLAMETTE FALLS PEDIATRIC GROUP, PC
Active
Organization
WILLAMETTE FALLS PEDIATRIC GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHRISTINA MARIE GRUCELLA M.D. (PRESIDENT)
(503) 905-3400
Entity
Organization
Contact information
Practice address
200 SOUTH HAZEL DELL WAY, SUITE 202, CANBY, OR 97013
(503) 266-8500
(503) 266-8585
Mailing address
1510 DIVISION ST, SUITE 280, OREGON CITY, OR 97045-1581
(503) 905-3400
(503) 905-3399
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
1292945-0
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
028484
—
OR
Enumeration date
06/26/2008
Last updated
06/26/2008
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