Healthcare Provider Details

I. General information

NPI: 1003701244
Provider Name (Legal Business Name): SARHA ELENA RUSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 S MOODY AVE
PORTLAND OR
97201-5042
US

IV. Provider business mailing address

619 NW 6TH AVE FL 5
PORTLAND OR
97209-3991
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-3633
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: