Provider Demographics
NPI:1649555145
Name:FRIDA CENTER LLC
Entity type:Organization
Organization Name:FRIDA CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GINEVRA
Authorized Official - Middle Name:LOIS
Authorized Official - Last Name:LIPTAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-477-9616
Mailing Address - Street 1:6400 SW CANYON CT
Mailing Address - Street 2:STE 100
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-1459
Mailing Address - Country:US
Mailing Address - Phone:503-477-9616
Mailing Address - Fax:503-477-9808
Practice Address - Street 1:6400 SW CANYON CT
Practice Address - Street 2:STE 100
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-1461
Practice Address - Country:US
Practice Address - Phone:503-477-9616
Practice Address - Fax:503-477-9808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-15
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR28421208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty