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NPI Code Detail

MEDICARE: PACIFIC O&P LLC

MEDICARE: PACIFIC O&P LLC
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
1332B00000XDurable Medical Equipment & Medical Supplies

General Provider Information

NPI Number : 1184260325
Entity Type Code : Organization
Provider Name (Legal Business Name) : PACIFIC O&P LLC
Provider Business Mailing Address
First Line : 1050 SW 6TH AVE STE 1100
Second Line :
City : PORTLAND
State : OR
Zip : 97204-1153
Country : US
Telephone Number : 800-251-0096
Fax Number :
Provider Business Practice Location Address
First Line : 1050 SW 6TH AVE STE 1100
Second Line :
City : PORTLAND
State : OR
Zip : 97204-1153
Country : US
Telephone Number : 800-251-0096
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MR. FERNANDO NISENBAUM
Credential :
Telephone Number : 800-251-0096
Provider Enumeration Date : 11/22/2019
Last Update Date : 11/22/2019

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Directions to “PACIFIC O&P LLC ” Practice Location

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