Healthcare Provider Details

I. General information

NPI: 1346035573
Provider Name (Legal Business Name): BIANCA DIAMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 04/09/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14725 SE RHONE ST
PORTLAND OR
97236-2556
US

IV. Provider business mailing address

14725 SE RHONE ST
PORTLAND OR
97236-2556
US

V. Phone/Fax

Practice location:
  • Phone: 503-666-6575
  • Fax: 503-491-3395
Mailing address:
  • Phone: 503-666-6575
  • Fax: 503-491-3395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: