Healthcare Provider Details

I. General information

NPI: 1265153811
Provider Name (Legal Business Name): MRS. ANGELICA OLVERA SANCHEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 09/12/2022
Certification Date: 09/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 SW 217TH PL
BEAVERTON OR
97003-1692
US

IV. Provider business mailing address

2204 SW 217TH PL
BEAVERTON OR
97003-1692
US

V. Phone/Fax

Practice location:
  • Phone: 503-927-8002
  • Fax:
Mailing address:
  • Phone: 503-927-8002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number8939201
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: