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General NPI Number Information
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NPI Number | 1417884545
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Entity Type | Individual
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Provider Name | IVANA LUCIA CAMARGO
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Gender | Female
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Dates
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Enumeration Date | 05/05/2026
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Last Update Date | 05/05/2026
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Provider Practice Location Address
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Address Line | 363 SE 6TH AVE
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City | HILLSBORO
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State | OR
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Zip | 97123-4110
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Country | US
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Telephone | 971-713-3930
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Fax |
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Provider Business Mailing Address
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Address Line | 10675 SW MURDOCK ST # I-8
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City | TIGARD
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State | OR
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Zip | 97224-3641
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | 115966
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License Number State | OR
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