Individual
RAYMOND DEGUILIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
5336 SE BUSH ST, PORTLAND, OR 97206-5394
(503) 737-5220
Mailing address
4109 SE 66TH AVE, PORTLAND, OR 97206-3656
(503) 737-5220
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
13047
OR
Other
Enumeration date
10/27/2014
Last updated
10/27/2014
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