=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720998099
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAZMYNE PATRICE BISQUERA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2026
-----------------------------------------------------
Last Update Date | 09/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6605 SE LAKE RD
-----------------------------------------------------
City | MILWAUKIE
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97222-2161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-655-8471
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6285 CALDWELL RD APT 59
-----------------------------------------------------
City | GLADSTONE
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97027-1572
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-901-5498
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number | C102666
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------