Provider Demographics
NPI:1710139449
Name:MADERAZO, HAROLD J (ND)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:J
Last Name:MADERAZO
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22914
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97269-2914
Mailing Address - Country:US
Mailing Address - Phone:503-358-1013
Mailing Address - Fax:
Practice Address - Street 1:9925 SW NIMBUS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-7387
Practice Address - Country:US
Practice Address - Phone:503-358-1013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-13
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1104175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath