Individual
ABDURAKHMON RADZHABOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
16940 TRACY AVE, LAKE OSWEGO, OR 97035-4558
(551) 258-7270
Mailing address
16940 TRACY AVE, LAKE OSWEGO, OR 97035-4558
(551) 258-7270
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
519252
OR
Other
Enumeration date
05/18/2023
Last updated
05/18/2023
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