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Individual

MR. JASON FORTUNO VILLAREAL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PT

Contact information

Practice address
1740 THOMPSON RD, COOS BAY, OR 97420-2151
(541) 266-3658
Mailing address
2808 E BURNSIDE ST, PORTLAND, OR 97214-1830
(503) 477-4802
(503) 477-9395

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT32980
CA

Other

Enumeration date
08/01/2006
Last updated
07/07/2016
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