Individual
SUPREETHA GUBBALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
51377 SW OLD PORTLAND RD, SCAPPOOSE, OR 97056-4023
(503) 418-4222
(503) 418-4223
Mailing address
335 SE 8TH AVE, HILLSBORO, OR 97123-4246
(503) 681-1050
(503) 681-1939
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD212377
OR
Other
Enumeration date
03/31/2019
Last updated
11/08/2022
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