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General NPI Number Information
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NPI Number | 1649138199
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Entity Type | Individual
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Provider Name | ISAIAH FABIAN DE ALBA
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Gender | Male
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Dates
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Enumeration Date | 01/13/2026
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Last Update Date | 01/13/2026
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Provider Practice Location Address
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Address Line | 4900 SW GRIFFITH DR STE 157
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City | BEAVERTON
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State | OR
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Zip | 97005-2977
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Country | US
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Telephone | 503-444-8230
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Fax | 503-295-4036
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Provider Business Mailing Address
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Address Line | 12390 NW BARNES RD APT 281
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City | PORTLAND
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State | OR
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Zip | 97229-6048
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Country | US
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Telephone | 626-756-7912
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | OR
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