Individual
MARISA QUIJANO PEDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
6030 SE DIVISION ST, PORTLAND, OR 97206-1346
(503) 772-1215
Mailing address
6030 SE DIVISION ST, PORTLAND, OR 97206-1346
(503) 772-1215
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
12/05/2008
Last updated
12/05/2008
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