Organization
ROSE CITY HEALTH CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANGELA D CORTAL ND (OWNER)
(503) 960-2162
Entity
Organization
Contact information
Practice address
5308 SE RHONE ST, PORTLAND, OR 97206-2962
(503) 960-2162
(503) 967-7069
Mailing address
5308 SE RHONE ST, PORTLAND, OR 97206-2962
(503) 960-2162
(503) 967-7069
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
1917
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1609128479
PROVIDER NPI TYPE 1
—
01
—
1917
STATE LICENSE NUMBER
OR
Enumeration date
09/17/2013
Last updated
09/17/2013
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