Healthcare Provider Details

I. General information

NPI: 1831067370
Provider Name (Legal Business Name): PETER VERGARI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9809 N MIDWAY AVE
PORTLAND OR
97203-1838
US

IV. Provider business mailing address

9809 N MIDWAY AVE
PORTLAND OR
97203-1838
US

V. Phone/Fax

Practice location:
  • Phone: 541-844-9907
  • Fax:
Mailing address:
  • Phone: 541-844-9907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10004385
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10004385
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: