Provider Demographics
NPI:1639597941
Name:JETMALANI, ASHA
Entity type:Individual
Prefix:
First Name:ASHA
Middle Name:
Last Name:JETMALANI
Suffix:
Gender:
Credentials:
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 19272
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97280-0272
Mailing Address - Country:US
Mailing Address - Phone:971-414-4020
Mailing Address - Fax:971-233-6460
Practice Address - Street 1:1110 SE ALDER ST, SUITE 301, PMB 107
Practice Address - Street 2:PMB 107
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214
Practice Address - Country:US
Practice Address - Phone:971-414-4020
Practice Address - Fax:971-233-6460
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO1764042084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry