Healthcare Provider Details

I. General information

NPI: 1568150878
Provider Name (Legal Business Name): LESLEY JILLIE CRUZ-ROJAS EFDA, EFODA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10315 NE TANASBOURNE DR
HILLSBORO OR
97124-7836
US

IV. Provider business mailing address

20770 SW JAY ST
BEAVERTON OR
97003-1511
US

V. Phone/Fax

Practice location:
  • Phone: 503-286-6868
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number000361
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: