Healthcare Provider Details

I. General information

NPI: 1265397970
Provider Name (Legal Business Name): JENNY MONTERROZA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 E BURNSIDE ST
PORTLAND OR
97214-1453
US

IV. Provider business mailing address

232 NW 6TH AVE
PORTLAND OR
97209-3609
US

V. Phone/Fax

Practice location:
  • Phone: 971-271-6066
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10052134
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: