Individual
NICHOLAS DOMENICHINI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSS
Contact information
Practice address
6200 SE KING RD, PORTLAND, OR 97222-2891
(503) 437-5900
Mailing address
6200 SE KING RD, PORTLAND, OR 97222-2891
(503) 437-5900
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
THW00108066
OR
Other
Enumeration date
01/13/2023
Last updated
01/13/2023
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