Individual
IVAN TAPIA HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
130 SE 105TH AVE APT C1, PORTLAND, OR 97216-2955
(707) 849-4576
Mailing address
130 SE 105TH AVE APT C1, PORTLAND, OR 97216-2955
(707) 849-4576
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/18/2019
Last updated
05/27/2025
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