Individual
MITALIBEN RAJENDRAKUMAR GOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1900 WOODLAND DR, COOS BAY, OR 97420-2099
(541) 267-5151
Mailing address
705 EDWARDS AVE, COOS BAY, OR 97420-3408
(541) 404-1414
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
201909528NP-PP
OR
Other
Enumeration date
12/03/2019
Last updated
12/03/2019
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