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General NPI Number Information
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NPI Number | 1245436385
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Entity Type | Organization
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Legal Business Name | TANASBOURNE PEDIATRICS, LLC
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1881 NW 185TH AVE SUITE 207
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City | ALOHA
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State | OR
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Zip | 97006-6822
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Country | US
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Telephone | 503-690-8195
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Fax | 503-629-5806
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Provider Business Mailing Address
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Address Line | 1881 NW 185TH AVE SUITE 207
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City | ALOHA
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State | OR
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Zip | 97006-6822
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Country | US
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Telephone | 503-690-8195
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Fax | 503-629-5806
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. RAQUEL MARIE APODACA
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Credential | MD
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Telephone | 503-690-8195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD21108
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License Number State | OR
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