MEDICARE: MS. MERCEDES SIENTO GONZALEZ R.N.

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	163WH0200X	Home Health Registered Nurse	077039751 RN	CA

General Provider Information

NPI Number	:	1356783328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MERCEDES SIENTO GONZALEZ R.N.

Provider Business Mailing Address
First Line	:	2027 NE MULTNOMAH ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-2188
Country	:	US
Telephone Number	:	503-288-3932
Fax Number	:	503-288-3932

Provider Business Practice Location Address
First Line	:	2027 NE MULTNOMAH ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-2188
Country	:	US
Telephone Number	:	503-288-3932
Fax Number	:	503-288-3932

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

Provider Enumeration Date	:	07/19/2013
Last Update Date	:	07/19/2013

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