Individual
GLENN YAMAGATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8832 SE 16TH AVE, PORTLAND, OR 97202-7219
(503) 486-7377
Mailing address
8832 SE 16TH AVE, PORTLAND, OR 97202-7219
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
06/05/2024
Last updated
06/05/2024
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