Individual
MRS. LISA A FARGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
3800 SW CEDAR HILLS BLVD, #203, BEAVERTON, OR 97005-2027
(971) 645-2257
Mailing address
13165 SW ESSEX DR, TIGARD, OR 97223-5646
(971) 645-2257
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
11230
OR
Other
Enumeration date
09/21/2006
Last updated
07/08/2007
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