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General NPI Number Information
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NPI Number | 1457041154
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Entity Type | Individual
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Provider Name | JACOB SALDIVAR
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Gender | Male
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Dates
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Enumeration Date | 05/08/2023
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 5308 N LOMBARD ST
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City | PORTLAND
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State | OR
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Zip | 97203-4218
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Country | US
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Telephone | 888-227-3312
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Fax | 971-282-0085
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Provider Business Mailing Address
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Address Line | PO BOX 2908
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City | PORTLAND
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State | OR
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Zip | 97208-2908
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Country | US
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Telephone | 425-207-5155
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA223193
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License Number State | OR
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