Organization
NW INSITUTO LATINO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIGUEL TELLEZ (EXECUTIVE DIRECTOR)
(503) 888-3464
Entity
Organization
Contact information
Practice address
2054 N VANCOUVER AVE, PORTLAND, OR 97227-1917
(503) 888-3464
Mailing address
775 NE 9TH ST, GRESHAM, OR 97030-5668
(503) 888-3464
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
04/14/2020
Last updated
04/14/2020
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