Healthcare Provider Details

I. General information

NPI: 1710003140
Provider Name (Legal Business Name): OPTUMCARE PORTLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9450 SW BARNES RD STE 100
PORTLAND OR
97225
US

IV. Provider business mailing address

9450 SW BARNES RD STE 100
PORTLAND OR
97225-6642
US

V. Phone/Fax

Practice location:
  • Phone: 503-292-9560
  • Fax: 503-292-9510
Mailing address:
  • Phone: 503-292-9560
  • Fax: 503-292-9510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: BRENDA CASTILLO
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 503-384-2027