Healthcare Provider Details

I. General information

NPI: 1760060461
Provider Name (Legal Business Name): CESAR SABOGAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 N PROVIDENCE DR
NEWBERG OR
97132-7485
US

IV. Provider business mailing address

1001 N PROVIDENCE DR
NEWBERG OR
97132-7485
US

V. Phone/Fax

Practice location:
  • Phone: 503-537-1555
  • Fax:
Mailing address:
  • Phone: 503-537-1555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD218262
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: