=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083388409
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NILZA GUADALUPE MONTANO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2021
-----------------------------------------------------
Last Update Date | 08/09/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 447 NE 47TH AVE STE 200
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97213-2362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-215-9160
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8615 SW MAVERICK TER APT 414
-----------------------------------------------------
City | BEAVERTON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97008-7436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-894-2376
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------