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General NPI Number Information
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NPI Number | 1861937237
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Entity Type | Organization
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Legal Business Name | MALACHAI INVESTMENTS LLC
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Dates
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Enumeration Date | 12/21/2016
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Last Update Date | 12/21/2016
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Provider Practice Location Address
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Address Line | 10,000 SE MAIN ST STE 360
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City | PORTLAND
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State | OR
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Zip | 97216
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Country | US
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Telephone | 503-253-4000
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Fax | 503-253-4002
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Provider Business Mailing Address
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Address Line | 10,000 SE MAIN ST STE 360
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City | PORTLAND
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State | OR
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Zip | 97216
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Country | US
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Telephone | 503-253-4000
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Fax | 503-253-4002
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DARELL CAMERON BRETT SR.
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Credential | MD
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Telephone | 503-253-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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