Individual
DR. SANDRA ANA ANTONOVIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
12442 SW SCHOLLS FERRY RD, SUITE 205, TIGARD, OR 97223-0804
(503) 216-9140
(503) 216-9145
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD23792
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
272420
—
OR
Enumeration date
01/09/2007
Last updated
10/13/2020
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