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General NPI Number Information
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NPI Number | 1366620676
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Entity Type | Organization
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Legal Business Name | AUGUSTINE GONZALES
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Dates
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Enumeration Date | 02/08/2008
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 2880 HAYES ST
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City | NEWBERG
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State | OR
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Zip | 97132-1310
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Country | US
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Telephone | 503-537-9600
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Fax | 503-537-0105
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Provider Business Mailing Address
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Address Line | 2880 HAYES ST
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City | NEWBERG
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State | OR
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Zip | 97132-1310
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Country | US
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Telephone | 503-537-9600
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Fax | 503-537-0105
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Authorized Official
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Title or Position | ADMINISTRATOR/OWNER
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Name | MR. AUGUSTINE GONZALES
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Credential |
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Telephone | 503-537-9600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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