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General NPI Number Information
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NPI Number | 1609453992
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Entity Type | Organization
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Legal Business Name | PATH SOLARIS LLC
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Dates
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Enumeration Date | 03/24/2021
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Last Update Date | 03/24/2021
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Provider Practice Location Address
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Address Line | 1842 NW 25TH AVE STE D
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City | PORTLAND
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State | OR
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Zip | 97210-2568
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Country | US
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Telephone | 415-254-4445
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Fax |
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Provider Business Mailing Address
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Address Line | 1842 NW 25TH AVE STE D
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City | PORTLAND
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State | OR
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Zip | 97210-2568
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Country | US
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Telephone | 415-254-4445
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Fax |
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Authorized Official
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Title or Position | DR
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Name | MICHELLE YAN
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Credential | DSOM, LA.,
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Telephone | 415-254-4445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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