Provider Demographics
NPI:1013530302
Name:HENRIQUEZ LOPEZ, CLAUDIA JESSY (MD)
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:JESSY
Last Name:HENRIQUEZ LOPEZ
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 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-8122
Mailing Address - Fax:503-494-1542
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-8122
Practice Address - Fax:503-494-1542
Is Sole Proprietor?:No
Enumeration Date:2020-05-21
Last Update Date:2023-09-06
Deactivation Date:2022-01-18
Deactivation Code:
Reactivation Date:2022-02-21
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORMD2144932080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program