Provider Demographics
NPI:1710195508
Name:DURAN, MARIA CRISTINA CRUZ (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA CRISTINA
Middle Name:CRUZ
Last Name:DURAN
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 1:15950 SW MILLIKAN WAY
Mailing Address - Street 2:THE PORTLAND CLINIC
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-5170
Mailing Address - Country:US
Mailing Address - Phone:503-221-0161
Mailing Address - Fax:503-221-4451
Practice Address - Street 1:15950 SW MILLIKAN WAY
Practice Address - Street 2:THE PORTLAND CLINIC
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-5170
Practice Address - Country:US
Practice Address - Phone:503-221-0161
Practice Address - Fax:503-221-4451
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23228207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORH75860Medicare UPIN
OR113568Medicare ID - Type Unspecified