Healthcare Provider Details

I. General information

NPI: 1689595472
Provider Name (Legal Business Name): COURTNEY VALE MOSES LE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12950 SW PACIFIC HWY STE 243
TIGARD OR
97223-5061
US

IV. Provider business mailing address

12950 SW PACIFIC HWY STE 243
TIGARD OR
97223-5061
US

V. Phone/Fax

Practice location:
  • Phone: 503-343-5596
  • Fax:
Mailing address:
  • Phone: 503-343-5596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberBAP-E-10273641
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: