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General NPI Number Information
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NPI Number | 1639597941
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Entity Type | Individual
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Provider Name | ASHA JETMALANI
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Gender | Female
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Dates
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Enumeration Date | 04/03/2014
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 1110 SE ALDER ST, SUITE 301, PMB 107 PMB 107
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City | PORTLAND
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State | OR
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Zip | 97214
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Country | US
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Telephone | 971-414-4020
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Fax | 971-233-6460
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Provider Business Mailing Address
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Address Line | PO BOX 19272
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City | PORTLAND
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State | OR
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Zip | 97280-0272
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Country | US
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Telephone | 971-414-4020
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Fax | 971-233-6460
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | DO176404
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License Number State | OR
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