Healthcare Provider Details

I. General information

NPI: 1912376534
Provider Name (Legal Business Name): FUSION HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2015
Last Update Date: 09/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2284 ROGUE WAY
WEST LINN OR
97068-8322
US

IV. Provider business mailing address

2284 ROGUE WAY
WEST LINN OR
97068-8322
US

V. Phone/Fax

Practice location:
  • Phone: 503-407-8286
  • Fax:
Mailing address:
  • Phone: 503-407-8286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number207QA0401X
License Number StateOR

VIII. Authorized Official

Name: DR. LOUIS PENG
Title or Position: MD/OWNER
Credential: MD
Phone: 503-407-8286