Healthcare Provider Details

I. General information

NPI: 1255741773
Provider Name (Legal Business Name): MRS. SARAH DANGARAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2014
Last Update Date: 05/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 NW CIVIC DR 310
GRESHAM OR
97030-3770
US

IV. Provider business mailing address

196 SE SPOKANE ST 108
PORTLAND OR
97202-6477
US

V. Phone/Fax

Practice location:
  • Phone: 503-666-8832
  • Fax:
Mailing address:
  • Phone: 503-805-0920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: