Provider Demographics
NPI:1376973750
Name:MUNOZ-ZARATE, JESUS ROBERTO (CADC1)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:ROBERTO
Last Name:MUNOZ-ZARATE
Suffix:
Gender:M
Credentials:CADC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9370 SW GREENBURG RD
Mailing Address - Street 2:SUITE 601
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5442
Mailing Address - Country:US
Mailing Address - Phone:503-246-5238
Mailing Address - Fax:503-246-0570
Practice Address - Street 1:9370 SW GREENBURG RD
Practice Address - Street 2:SUITE 601
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-5442
Practice Address - Country:US
Practice Address - Phone:503-246-5238
Practice Address - Fax:503-246-0570
Is Sole Proprietor?:No
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR05- P-04101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)