Healthcare Provider Details

I. General information

NPI: 1710890777
Provider Name (Legal Business Name): TINA LOUISE HOOVER-MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8910 SE WOODSTOCK BLVD
PORTLAND OR
97266-5320
US

IV. Provider business mailing address

8910 SE WOODSTOCK BLVD
PORTLAND OR
97266-5320
US

V. Phone/Fax

Practice location:
  • Phone: 503-406-0290
  • Fax:
Mailing address:
  • Phone: 503-406-0290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number117521
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: