Most Relevant Information
Provider Data
| NPI Number: | 1003439084 |
| Provider Name: | SAMUEL BRYAN VALDIVIA |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/25/2020 |
| Last Updated: | 10/28/2022 |
Provider Practice Location
501 N GRAHAM ST MEDICAL OFFICE BUILDING 2
SUITE 220
PORTLAND
OR
97227
Practice Location Phone/Fax
| Phone: | 5034136200 |
| Fax: |
Provider Mailing Location
1701 SW COLUMBIA ST APT 404
PORTLAND
OR
972012592
Provider Mailing Phone/Fax
| Phone: | 6024035363 |
| Fax: |