Healthcare Provider Details

I. General information

NPI: 1235060179
Provider Name (Legal Business Name): ELITE TESTOSTERONE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14355 SW ALLEN BLVD STE 250
BEAVERTON OR
97005-4700
US

IV. Provider business mailing address

14355 SW ALLEN BLVD STE 250
BEAVERTON OR
97005-4700
US

V. Phone/Fax

Practice location:
  • Phone: 503-897-7329
  • Fax: 503-386-3339
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: SARAH CHICHARRO
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 503-897-7329