Individual
MARIO ALFONSO CARDENAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10570 SE WASHINGTON ST, PORTLAND, OR 97216-2846
(503) 995-3736
Mailing address
2336 NE FRANCIS PL, GRESHAM, OR 97030-3210
(503) 995-3736
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
175T00000X
Peer Specialist
12-CRM-074
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12-CRM-074
—
OR
Enumeration date
02/17/2016
Last updated
07/21/2022
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