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General NPI Number Information
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NPI Number | 1992942064
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Entity Type | Organization
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Legal Business Name | LESTER TENGSICO LLC
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Dates
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Enumeration Date | 01/12/2009
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Last Update Date | 01/12/2009
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Provider Practice Location Address
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Address Line | 10424 SE CHERRY BLOSSOM DR STE F
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City | PORTLAND
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State | OR
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Zip | 97216-2825
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Country | US
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Telephone | 503-760-5151
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Fax | 503-760-5454
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Provider Business Mailing Address
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Address Line | PO BOX 33912
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City | PORTLAND
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State | OR
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Zip | 97292-3912
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Country | US
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Telephone | 503-760-5151
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Fax | 503-760-5454
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Authorized Official
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Title or Position | OWNER
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Name | LESTER TENGSICO
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Credential |
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Telephone | 503-760-5151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | DP00263
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | DP00263
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | DP00263
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License Number State | OR
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