Individual
SALEEN D MANTERNACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-7008
(503) 494-4997
Mailing address
333 S STATE ST, STE V181, LAKE OSWEGO, OR 97034-3932
(559) 970-9487
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
A84270
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
CA
Enumeration date
08/01/2006
Last updated
05/11/2011
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