Healthcare Provider Details

I. General information

NPI: 1538964135
Provider Name (Legal Business Name): MATEO MELIUS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 SW 105TH AVE STE 101
BEAVERTON OR
97008-5488
US

IV. Provider business mailing address

6800 SW 105TH AVE STE 101
BEAVERTON OR
97008-5488
US

V. Phone/Fax

Practice location:
  • Phone: 971-200-1966
  • Fax:
Mailing address:
  • Phone: 971-200-1966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: