Individual
KUFA DEKAMO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3708 SE 144TH AVE, PORTLAND, OR 97236-2731
(571) 315-7771
Mailing address
3708 SE 144TH AVE, PORTLAND, OR 97236-2731
(571) 315-7771
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
201802274LPN
OR
Other
Enumeration date
04/21/2018
Last updated
04/21/2018
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