Provider Demographics
NPI:1710112586
Name:PORTUONDO, EMELIA MADELEINE (ND)
Entity Type:Individual
Prefix:DR
First Name:EMELIA
Middle Name:MADELEINE
Last Name:PORTUONDO
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:MADELEINE
Other - Middle Name:
Other - Last Name:PORTUONDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ND
Mailing Address - Street 1:22400 SE STARK ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-2656
Mailing Address - Country:US
Mailing Address - Phone:503-492-1221
Mailing Address - Fax:503-907-0098
Practice Address - Street 1:22400 SE STARK ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-2656
Practice Address - Country:US
Practice Address - Phone:503-492-1221
Practice Address - Fax:503-907-0098
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-22
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3070175F00000X
OR106-OB176B00000X
HI185175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No176B00000XOther Service ProvidersMidwife