Individual
ALI FARES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10714 NE GLISAN ST, PORTLAND, OR 97220-4046
(503) 256-2453
Mailing address
11547 SW 64TH AVE, PORTLAND, OR 97219-7099
(773) 757-4115
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/16/2024
Last updated
04/18/2024
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