Provider Demographics
NPI:1508130204
Name:GUENZI, CHRISTINE (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:GUENZI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WILLAMETTE FALLS PEDIATRIC GROUP
Mailing Address - Street 2:1510 DIVISION ST SUITE 280
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045
Mailing Address - Country:US
Mailing Address - Phone:503-905-3400
Mailing Address - Fax:503-905-3399
Practice Address - Street 1:WILLAMETTE FALLS PEDIATRIC GROUP 1510 DIVISION ST
Practice Address - Street 2:SUITE 280
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045
Practice Address - Country:US
Practice Address - Phone:503-905-3400
Practice Address - Fax:503-905-3399
Is Sole Proprietor?:No
Enumeration Date:2012-02-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD183765208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500726323Medicaid