Provider Demographics
NPI:1932816899
Name:MATEI, LEONARD (CPHT)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:
Last Name:MATEI
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 NE 33RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-5113
Mailing Address - Country:US
Mailing Address - Phone:503-535-6031
Mailing Address - Fax:503-946-3854
Practice Address - Street 1:1821 NE 33RD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-5113
Practice Address - Country:US
Practice Address - Phone:503-535-6031
Practice Address - Fax:503-946-3854
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-01
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVB-61354257183700000X
ORCPT-0015031183700000X
30215078183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORCPT-0015031OtherCERTIFIED OREGON PHARMACY TECHNICIAN
WAVB-61354257OtherCERTIFIED PHARMACY TECHNICIAN
WAVB-61354257OtherCERTIFIED PHARMACY TECHNICIAN