Individual
CHETHIYA WELIGODAPOLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3303 S BOND AVE BLDG 1, PORTLAND, OR 97239-4501
(503) 494-1700
Mailing address
3303 S BOND AVE BLDG 1, PORTLAND, OR 97239-4501
(971) 285-0370
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA210795
OR
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
05/23/2020
Last updated
11/10/2022
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