Healthcare Provider Details

I. General information

NPI: 1871750919
Provider Name (Legal Business Name): HORIZON PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9735 SW SHADY LN STE 300
TIGARD OR
97223-5481
US

IV. Provider business mailing address

9735 SW SHADY LN STE 300
TIGARD OR
97223-5481
US

V. Phone/Fax

Practice location:
  • Phone: 503-598-9444
  • Fax:
Mailing address:
  • Phone: 503-598-9444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD21712
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ZAID S AL-MULLA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 503-598-9444