Healthcare Provider Details

I. General information

NPI: 1083206155
Provider Name (Legal Business Name): GO TO ORTHO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2695 SW CEDAR HILLS BLVD STE 140
BEAVERTON OR
97005-1415
US

IV. Provider business mailing address

2695 SW CEDAR HILLS BLVD # G140
BEAVERTON OR
97005-1392
US

V. Phone/Fax

Practice location:
  • Phone: 503-850-9950
  • Fax: 877-533-6717
Mailing address:
  • Phone: 503-850-9950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CRISTAL LOZANO
Title or Position: SITE DIRECTOR
Credential:
Phone: 503-850-9950