Individual
MARCELO AGUSTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3415 SE POWELL BLVD, PORTLAND, OR 97202-3371
(503) 234-9591
Mailing address
3415 SE POWELL BLVD, PORTLAND, OR 97202-3371
(503) 234-9591
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
201220087CMA
OR
Other
Enumeration date
08/18/2014
Last updated
08/18/2014
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