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Individual

CARLOS THOMAS BENSON MARTINEZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
12655 SW CENTER ST STE 100, BEAVERTON, OR 97005-1600
(617) 301-0447
(503) 828-3401
Mailing address
12577 SE RIVER RD APT 139, MILWAUKIE, OR 97222-8007
(617) 301-0447

Taxonomy

Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
THW000003795
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
THW000003795
THW CERTIFICATION #
OR
Enumeration date
10/04/2019
Last updated
10/04/2019
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