Individual
DASTU I AHMAT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
55 NW 23RD ST, GRESHAM, OR 97030-2640
(503) 984-6216
Mailing address
55 NW 23RD ST, GRESHAM, OR 97030-2640
(503) 984-6216
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
11146
OR
Other
Enumeration date
02/27/2019
Last updated
02/27/2019
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