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General NPI Number Information
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NPI Number | 1255682332
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Entity Type | Organization
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Legal Business Name | ESSENTIAL HEALTH CLINIC
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Dates
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Enumeration Date | 09/28/2012
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Last Update Date | 09/28/2012
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Provider Practice Location Address
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Address Line | 266 W MAIN ST
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City | HILLSBORO
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State | OR
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Zip | 97123-3961
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Country | US
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Telephone | 503-846-4904
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Fax | 503-846-4493
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Provider Business Mailing Address
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Address Line | 266 WEST MAIN ST
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City | HILLSBORO
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State | OR
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Zip | 97123-3961
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Country | US
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Telephone | 503-846-4904
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Fax | 503-846-4493
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SOPHIA TZENG
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Credential | JD
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Telephone | 503-974-6313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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