MEDICARE: PARDISE MOSSALMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171400000X	Health & Wellness Coach		OR

General Provider Information

NPI Number	:	1043175680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PARDISE MOSSALMAN

Provider Business Mailing Address
First Line	:	15875 BOONES FERRY RD UNIT 1426
Second Line	:
City	:	LAKE GROVE
State	:	OR
Zip	:	97035-0811
Country	:	US
Telephone Number	:	503-917-9494
Fax Number	:

Provider Business Practice Location Address
First Line	:	15110 BOONES FERRY RD STE 370
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-3461
Country	:	US
Telephone Number	:	503-917-9494
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2025
Last Update Date	:	12/17/2025

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