Individual
MR. REX BAZAR FELINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
14318 SE STARK ST, APT. 3, PORTLAND, OR 97233-2172
(503) 957-3493
Mailing address
14318 SE STARK ST APT 3, PORTLAND, OR 97233-2172
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
17471
OR
Other
Enumeration date
12/14/2012
Last updated
12/14/2012
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