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Individual

MATILDA MARTHA MENGIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
412 SW 12TH AVE, PORTLAND, OR 97205-2329
(503) 228-7134
(503) 273-8431
Mailing address
2721 SW MONTGOMERY DR, PORTLAND, OR 97201-1692
(503) 936-2324

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
G83302
CA
2084P0800X
Psychiatry Physician
Primary
MD23525
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
286525
OR
Enumeration date
11/29/2006
Last updated
07/08/2007
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