Provider Demographics
NPI:1346094315
Name:GAZURIAN, SARAH BUSTAMANTE
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:BUSTAMANTE
Last Name:GAZURIAN
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 1:10449 SE ELLIS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-4117
Mailing Address - Country:US
Mailing Address - Phone:971-282-5729
Mailing Address - Fax:
Practice Address - Street 1:11300 NE HALSEY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-2026
Practice Address - Country:US
Practice Address - Phone:503-252-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12158432235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist