Healthcare Provider Details

I. General information

NPI: 1043175680
Provider Name (Legal Business Name): PARDISE MOSSALMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15110 BOONES FERRY RD STE 370
LAKE OSWEGO OR
97035-3461
US

IV. Provider business mailing address

15875 BOONES FERRY RD UNIT 1426
LAKE GROVE OR
97035-0811
US

V. Phone/Fax

Practice location:
  • Phone: 503-917-9494
  • Fax:
Mailing address:
  • Phone: 503-917-9494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: