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NPI Code Detail

MEDICARE: BRIELLE VANESSA GOLDSTEIN MD

MEDICARE: BRIELLE VANESSA GOLDSTEIN MD
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
1390200000XStudent in an Organized Health Care Education/Training ProgramOR

General Provider Information

NPI Number : 1790627404
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIELLE VANESSA GOLDSTEIN MD
Provider Business Mailing Address
First Line : 3181 SW SAM JACKSON PARK RD
Second Line :
City : PORTLAND
State : OR
Zip : 97239-3098
Country : US
Telephone Number : 503-494-8211
Fax Number :
Provider Business Practice Location Address
First Line : 3181 SW SAM JACKSON PARK RD
Second Line :
City : PORTLAND
State : OR
Zip : 97239-3098
Country : US
Telephone Number : 503-494-8211
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2026
Last Update Date : 04/09/2026

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