Individual
DR. JUAN CARLOS GONZALEZ-VITALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2801 N GANTENBEIN AVE, PORTLAND, OR 97227-1623
(503) 413-4813
(503) 413-2982
Mailing address
2801 N GANTENBEIN AVE, PORTLAND, OR 97227-1623
(503) 413-4813
(503) 413-2982
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
MD16262
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0134819
—
OR
01
—
036629
OREGON WELFARE
—
05
—
036629
—
OR
Enumeration date
02/01/2007
Last updated
05/07/2009
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