Healthcare Provider Details

I. General information

NPI: 1124585849
Provider Name (Legal Business Name): NATALIA K BURGESS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2019
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 SE CESAR E CHAVEZ BLVD
PORTLAND OR
97214-3216
US

IV. Provider business mailing address

4101 NE DIVISION ST
GRESHAM OR
97030-4617
US

V. Phone/Fax

Practice location:
  • Phone: 503-231-7480
  • Fax:
Mailing address:
  • Phone: 503-666-6575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: