Individual
TRISTAN LANE HERBERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1232 NW 23RD AVE, PORTLAND, OR 97210-2906
(503) 227-3450
Mailing address
3123 SW DOLPH CT, #1, PORTLAND, OR 97219
(502) 223-1117
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
372600000X
Adult Companion
—
—
Other
Enumeration date
04/16/2007
Last updated
09/15/2007
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