Individual
RILEY YOUNG HOSEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3944 N MISSISSIPPI AVE, PORTLAND, OR 97227-1163
(503) 517-8222
Mailing address
2507 NE WASCO ST, PORTLAND, OR 97232-1738
(760) 207-6051
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
20006
OR
Other
Enumeration date
12/10/2013
Last updated
12/10/2013
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