Individual
MR. JUSTIN CUMMINGS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10105 N. OSWEGO AVE, PORTLAND, OR 97203
(505) 920-4345
Mailing address
103 W POWELL BLVD UNIT 1353, GRESHAM, OR 97030-0816
(505) 920-4345
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
Primary
—
—
Other
Enumeration date
05/14/2020
Last updated
05/14/2020
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