Provider Demographics
NPI:1336824564
Name:PAGUIO, ALMA BLANCAFLOR
Entity Type:Individual
Prefix:MISS
First Name:ALMA
Middle Name:BLANCAFLOR
Last Name:PAGUIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12808 NE CLACKAMAS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-2313
Mailing Address - Country:US
Mailing Address - Phone:503-254-3607
Mailing Address - Fax:503-345-6632
Practice Address - Street 1:12808 NE CLACKAMAS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-2313
Practice Address - Country:US
Practice Address - Phone:503-254-3607
Practice Address - Fax:503-345-6632
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11053311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home