Provider Demographics
NPI:1437866365
Name:ABDELJAWAD, MANAR
Entity Type:Individual
Prefix:
First Name:MANAR
Middle Name:
Last Name:ABDELJAWAD
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 1:13518 SW MARCIA DR
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-2088
Mailing Address - Country:US
Mailing Address - Phone:503-267-0195
Mailing Address - Fax:
Practice Address - Street 1:8212 SW LOCUST ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-5822
Practice Address - Country:US
Practice Address - Phone:503-244-2068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health