Healthcare Provider Details

I. General information

NPI: 1356783328
Provider Name (Legal Business Name): MERCEDES SIENTO GONZALEZ R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2013
Last Update Date: 07/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2027 NE MULTNOMAH ST
PORTLAND OR
97232-2188
US

IV. Provider business mailing address

2027 NE MULTNOMAH ST
PORTLAND OR
97232-2188
US

V. Phone/Fax

Practice location:
  • Phone: 503-288-3932
  • Fax: 503-288-3932
Mailing address:
  • Phone: 503-288-3932
  • Fax: 503-288-3932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number077039751 RN
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: