Individual
KIMBERLY SAMANTHA GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6200 SE KING RD, PORTLAND, OR 97222-2891
(503) 358-1177
Mailing address
6200 SE KING RD, PORTLAND, OR 97222-2891
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
112866
OR
Other
Enumeration date
01/17/2025
Last updated
01/17/2025
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