Healthcare Provider Details

I. General information

NPI: 1619888310
Provider Name (Legal Business Name): ELIZABETH GOMEZ-DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16365 NW TWIN OAKS DRIVE #200
BEAVERTON OR
97006
US

IV. Provider business mailing address

16055 SW WALKER RD # 443
BEAVERTON OR
97006-4942
US

V. Phone/Fax

Practice location:
  • Phone: 503-828-3402
  • Fax:
Mailing address:
  • Phone: 503-828-3402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: