Healthcare Provider Details

I. General information

NPI: 1700421583
Provider Name (Legal Business Name): MISS FRANCISCA YAC RISCAJCHE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2019
Last Update Date: 11/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17675 SW TUALATIN VALLEY HWY
BEAVERTON OR
97003-4443
US

IV. Provider business mailing address

635 SE 69TH CT
HILLSBORO OR
97123-3753
US

V. Phone/Fax

Practice location:
  • Phone: 503-259-3160
  • Fax:
Mailing address:
  • Phone: 971-770-8185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: