Individual
MR. ADILENE SANDOVAL I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10214 SE ELLIS ST, PORTLAND, OR 97266-4342
(503) 957-4241
Mailing address
10214 SE ELLIS ST, PORTLAND, OR 97266-4342
(503) 957-4241
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
01/12/2015
Last updated
01/12/2015
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