Provider Demographics
NPI:1295365559
Name:GONZALEZ ALBARADO, ROSA (EFDA)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:GONZALEZ ALBARADO
Suffix:
Gender:F
Credentials:EFDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12450 SW WALKER RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-1401
Mailing Address - Country:US
Mailing Address - Phone:503-277-1050
Mailing Address - Fax:
Practice Address - Street 1:12450 SW WALKER RD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-1401
Practice Address - Country:US
Practice Address - Phone:503-277-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR121326126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant