Provider Demographics
NPI:1407512940
Name:ARMENDARIZ, PATRICIO IVAN
Entity Type:Individual
Prefix:
First Name:PATRICIO
Middle Name:IVAN
Last Name:ARMENDARIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8383 NE SANDY BLVD, SUITE 110B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220
Mailing Address - Country:US
Mailing Address - Phone:971-373-4085
Mailing Address - Fax:971-373-5285
Practice Address - Street 1:8383 NE SANDY BLVD, SUITE 110B
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220
Practice Address - Country:US
Practice Address - Phone:971-373-4041
Practice Address - Fax:971-373-5285
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR7581101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health