Individual
SEVERIANO HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
16140 ELLENDALE RD, DALLAS, OR 97338-9667
(503) 623-3310
Mailing address
16140 ELLENDALE RD, DALLAS, OR 97338-9667
(503) 623-3310
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/04/2022
Last updated
01/04/2022
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