Provider Demographics
NPI:1093473035
Name:GAMEZ-CARRASCO, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:GAMEZ-CARRASCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3880 SE 8TH AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3772
Mailing Address - Country:US
Mailing Address - Phone:503-777-8290
Mailing Address - Fax:
Practice Address - Street 1:3880 SE 8TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-3772
Practice Address - Country:US
Practice Address - Phone:503-777-8290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist