NPI 1003439084

Samuel Bryan Valdivia

Practitioner Physician Assistant Portland, OR

Practice location

Address: 501 N Graham St Medical Office Building 2 Suite 220, Portland, OR 97227
Phone: (503) 413-6200
Mailing address: 1701 SW Columbia St APT 404, Portland, OR 97201-2592

Registered specialties (2)

Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363A00000X Licence PA213719 (OR)

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Student in an Organized Health Care Education/Training Program

Student, Health Care Taxonomy 390200000X

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Registry record

NPI: 1003439084
Entity type: Individual
Sex (as registered): Male
NPI issued: 25 May 2020
Record last updated: 28 Oct 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.