Healthcare Provider Details

I. General information

NPI: 1598936916
Provider Name (Legal Business Name): ALIA ALHUMAID MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CENTERPOINTE DR STE 400
LAKE OSWEGO OR
97035-8661
US

IV. Provider business mailing address

4004 KRUSE WAY PL STE 160
LAKE OSWEGO OR
97035-2449
US

V. Phone/Fax

Practice location:
  • Phone: 503-486-7276
  • Fax:
Mailing address:
  • Phone: 503-486-7276
  • Fax: 503-967-7108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number229898
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD191415
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: