Healthcare Provider Details

I. General information

NPI: 1790253441
Provider Name (Legal Business Name): NOEMI MARTINEZ-GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2018
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 NE BURNSIDE RD STE 701
GRESHAM OR
97030-5770
US

IV. Provider business mailing address

9701 SE JOHNSON CREEK BLVD APT O301
HAPPY VALLEY OR
97086-9618
US

V. Phone/Fax

Practice location:
  • Phone: 503-740-1971
  • Fax:
Mailing address:
  • Phone: 503-754-6946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: