Individual
DIEUSON ALIX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11097 SE 21ST AVE, MILWAUKIE, OR 97222-7640
(971) 334-9295
Mailing address
11277 SE STEVENS RD APT 301, HAPPY VALLEY, OR 97086-4510
(503) 278-6448
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
THW000106457
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
THW000106457
—
OR
Enumeration date
05/25/2022
Last updated
05/25/2022
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