Healthcare Provider Details

I. General information

NPI: 1801391552
Provider Name (Legal Business Name): GABRIELA LUCIANA LILLY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GABRIELA LUCIANA BOBARNAC DOGARU MD

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 SW SAM JACKSON PARK RD
PORTLAND OR
97239-3011
US

IV. Provider business mailing address

3181 SW SAM JACKSON PARK RD
PORTLAND OR
97239-3011
US

V. Phone/Fax

Practice location:
  • Phone: 410-933-6423
  • Fax:
Mailing address:
  • Phone: 410-933-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberMD221628
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberD97956
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: