Healthcare Provider Details

I. General information

NPI: 1386763142
Provider Name (Legal Business Name): IVETTE M IPARRAGUIRRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 SW WASHINGTON ST
PORTLAND OR
97205-2327
US

IV. Provider business mailing address

1735 SW 208TH AVE
BEAVERTON OR
97006-1831
US

V. Phone/Fax

Practice location:
  • Phone: 503-535-1151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: