Individual
JOHN BLOMBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
9750 NE GLISAN ST, PORTLAND, OR 97220-4449
(503) 256-3920
Mailing address
11712 NW 38TH AVE, VANCOUVER, WA 98685-3550
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
P1 60569439
WA
Other
Enumeration date
10/27/2015
Last updated
10/27/2015
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