Individual
MERVIN PADUA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
1827 SE 76TH AVE, PORTLAND, OR 97215-3522
(503) 961-3416
Mailing address
1827 SE 76TH AVE, PORTLAND, OR 97215-3522
(503) 961-3416
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
201910495
OR
Other
Enumeration date
12/21/2023
Last updated
12/21/2023
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