NPI 1245065366

Shane Anthony Gonzales, CRM

Practitioner Substance Use Disorder Rehabilitation Clinic/Center Portland, OR

Practice location

Address: 1122 NE 122nd Ave STE A200, Portland, OR 97230-2083
Phone: (503) 594-4774

Registered specialties

Substance Use Disorder Rehabilitation Clinic/Center Primary

Ambulatory Health Care Facilities Taxonomy 261QR0405X

Other Clinic/Center providers in Oregon →

Registry record

NPI: 1245065366
Entity type: Individual
Sex (as registered): Male
NPI issued: 6 Sep 2024
Record last updated: 6 Sep 2024

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.