Organization
PORTLAND MEDICAL DIAGNOSTIC CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE MACIAS (SECRETARY)
(503) 408-7578
Entity
Organization
Contact information
Practice address
13232 SE STARK ST, SUITE 4, PORTLAND, OR 97233-1573
(503) 408-7578
(503) 408-7615
Mailing address
13232 SE STARK ST, PORTLAND, OR 97233-1573
(503) 408-7578
(503) 408-7615
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
10/15/2009
Last updated
10/15/2009
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