Organization
CITY OF PORTLAND
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALFERDO EDUARDO VERGARA PHD. (DIRECTOR, PUBLIC HEALTH DIVISION)
(207) 874-8446
Entity
Organization
Contact information
Practice address
39 FOREST AVE, PORTLAND, ME 04101-2912
(207) 874-8446
Mailing address
39 FOREST AVE, PORTLAND, ME 04101-2912
(207) 874-8446
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
H80CS00005-04-00
ME
261QP0905X
State or Local Public Health Clinic/Center
Primary
—
—
Other
Enumeration date
03/20/2007
Last updated
07/11/2024
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