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Organization
WILLAMETTE FALLS PEDIATRIC GROUP
Active
Organization
WILLAMETTE FALLS PEDIATRIC GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINA M GRUCELLA M.D. (PRESIDENT)
(503) 905-3400
Entity
Organization
Contact information
Practice address
1510 DIVISION ST, SUITE 280, OREGON CITY, OR 97045-1581
(503) 905-3400
(503) 905-3399
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
MD16083
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
028484
—
OR
01
—
820444000
BLUE CROSS BLUE SHIELD
OR
Enumeration date
02/22/2007
Last updated
06/16/2008
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