Healthcare Provider Details

I. General information

NPI: 1831721489
Provider Name (Legal Business Name): DOCERE NATUROPATHIC MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 NW 20TH ST
GRESHAM OR
97030-2441
US

IV. Provider business mailing address

4850 SW 11TH ST APT 133
GRESHAM OR
97080-7314
US

V. Phone/Fax

Practice location:
  • Phone: 503-489-5917
  • Fax:
Mailing address:
  • Phone: 503-929-5481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. MARIYA SULAKOV
Title or Position: MEMBER
Credential: ND
Phone: 503-489-5917