Healthcare Provider Details

I. General information

NPI: 1740871409
Provider Name (Legal Business Name): RAUL DANIEL COVACIU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2021
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6416 SE JACK RD
MILWAUKIE OR
97222-2830
US

IV. Provider business mailing address

6416 SE JACK RD
MILWAUKIE OR
97222-2830
US

V. Phone/Fax

Practice location:
  • Phone: 503-927-0489
  • Fax:
Mailing address:
  • Phone: 503-927-0489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number519218
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: