Individual
MELBA DOMINGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CEO
Contact information
Practice address
11707 NE GLISAN ST, PORTLAND, OR 97220-2141
(503) 444-7605
(971) 266-8643
Mailing address
11707 NE GLISAN ST, PORTLAND, OR 97220-2141
(503) 444-7605
(971) 266-8643
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
13-1520
OR
Other
Enumeration date
06/25/2015
Last updated
06/25/2015
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