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NPI Code Detail

MEDICARE: JEFF DINES

MEDICARE: JEFF DINES
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
1103K00000XBehavior Analyst

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11275967184OTHERORYOUTH PROGRESS ASSOCIATION

General Provider Information

NPI Number : 1588093488
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFF DINES
Provider Business Mailing Address
First Line : PO BOX 2476
Second Line :
City : PORTLAND
State : OR
Zip : 97208-2476
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2333 SE 12TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97214-5323
Country : US
Telephone Number : 503-235-0031
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2013
Last Update Date : 11/01/2013

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Directions to “ JEFF DINES ” Practice Location

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