Healthcare Provider Details

I. General information

NPI: 1336567445
Provider Name (Legal Business Name): MONICA M LLADO-FARRULLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2014
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 S BOND AVE
PORTLAND OR
97239-4501
US

IV. Provider business mailing address

3303 S BOND AVE
PORTLAND OR
97239-4501
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-2306
  • Fax: 504-988-1882
Mailing address:
  • Phone: 503-494-6687
  • Fax: 503-494-1717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number.
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD209561
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: