Healthcare Provider Details

I. General information

NPI: 1356788376
Provider Name (Legal Business Name): DAINA NGUGI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2013
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11035 NE SANDY BLVD
PORTLAND OR
97220-2553
US

IV. Provider business mailing address

11035 NE SANDY BLVD
PORTLAND OR
97220-2553
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-9452
  • Fax: 804-828-9282
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number0102204356
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: