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General NPI Number Information
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NPI Number | 1235869488
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Entity Type | Organization
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Legal Business Name | MINDRX, LLC
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Dates
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Enumeration Date | 06/11/2022
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 555 SE MLK JR BLVD UNIT 105
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City | PORTLAND
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State | OR
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Zip | 97214-2595
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Country | US
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Telephone | 503-664-9451
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Fax | 503-386-3230
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Provider Business Mailing Address
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Address Line | 3055 NW YEON AVE SUITE 606
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City | PORTLAND
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State | OR
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Zip | 97210
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Country | US
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Telephone | 503-664-9451
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ANTHONY GRIPPO
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Credential |
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Telephone | 503-664-9451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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