Healthcare Provider Details

I. General information

NPI: 1326199738
Provider Name (Legal Business Name): FRANCES VENTURA VERZOSA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10535 NE GLISAN ST STE.100
PORTLAND OR
97220-4077
US

IV. Provider business mailing address

410 NW ILWACO ST
CAMAS WA
98607-9047
US

V. Phone/Fax

Practice location:
  • Phone: 503-226-3579
  • Fax: 503-525-5875
Mailing address:
  • Phone: 360-834-6944
  • Fax: 503-525-5875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberMD13238
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: