Individual
JESUS ERNESTO CONRIQUE GARCIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4805 NE GLISAN ST, PORTLAND, OR 97213-2933
(503) 215-1111
Mailing address
907 SE 147TH AVE, VANCOUVER, WA 98683-8390
(503) 449-9673
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
202003860CNA
OR
Other
Enumeration date
10/01/2024
Last updated
10/01/2024
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