NPI 1265468615 · live from the CMS NPI Registry
Michelle D Bonta, MD
Dermatology in Portland, OR. National Provider Identifier 1265468615, active.
NPI record
| NPI | 1265468615 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dermatology 207N00000X |
| Practice location | 417 Sw 117th Ave, 2nd Floor, Portland, OR 97225 |
| Practice phone | 503-216-9400 |
| Mailing address | Po Box 3158, Portland, OR 97208 |
| Enumerated | June 25, 2006 |
| Last updated | October 15, 2020 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dermatology primary | 207N00000X | MD25129 (OR) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.