Healthcare Provider Details

I. General information

NPI: 1871001966
Provider Name (Legal Business Name): CRISTELL KARINA GONZALEZ PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2018
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 NW COUNCIL DR STE 300
GRESHAM OR
97030-3725
US

IV. Provider business mailing address

9945 NE SANDY BLVD UNIT 82
PORTLAND OR
97220-3309
US

V. Phone/Fax

Practice location:
  • Phone: 503-258-4600
  • Fax:
Mailing address:
  • Phone: 503-515-3932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: