Individual
JONATHAN EDWARD MONDRAGON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
16141 E. BURNSIDE ST., PORTLAND, OR 97233-3519
(503) 252-3949
(503) 252-4027
Mailing address
16141 E BURNSIDE ST, PORTLAND, OR 97233-3519
(503) 252-3949
(503) 252-4027
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
201130027LPN
OR
Other
Enumeration date
08/07/2012
Last updated
08/07/2012
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