Individual
JOHNATHON VASQUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRM
Contact information
Practice address
3231 SE 50TH AVE, PORTLAND, OR 97206-2248
(503) 560-5629
Mailing address
3231 SE 50TH AVE, PORTLAND, OR 97206-2248
(503) 560-5629
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
175T00000X
OR
Other
Enumeration date
05/28/2024
Last updated
05/28/2024
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