Provider Demographics
NPI:1144753914
Name:CARRENO, RACHAEL MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:RACHAEL
Middle Name:MARIE
Last Name:CARRENO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 NE HOYT ST STE 240
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-2981
Mailing Address - Country:US
Mailing Address - Phone:503-215-6480
Mailing Address - Fax:
Practice Address - Street 1:5050 NE HOYT ST STE 240
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2981
Practice Address - Country:US
Practice Address - Phone:503-215-6480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORDO203600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORDO203600OtherSTATE LICENSE
IN11019802AOtherSTATE LICENSE