Individual
BASETI GELGELU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2055 SW 79TH AVE, PORTLAND, OR 97225-3805
(206) 306-3730
Mailing address
2055 SW 79TH AVE, PORTLAND, OR 97225-3805
(206) 306-3730
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
525603
OR
Other
Enumeration date
09/23/2020
Last updated
09/23/2020
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