Shane Anthony Gonzales, C.R.M.
Clinic/Center, Rehabilitation, Substance Use Disorder in Portland, OR. Individual provider (NPI-1).
NPI number1245065366
StatusActive
Last updated in NPPESSep 6, 2024
Details
- NPI
- 1245065366
- Entity type
- Individual (NPI-1)
- Name
- Shane Anthony Gonzales
- Credential
- C.R.M.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Sep 6, 2024
- Certification date
- Sep 6, 2024
- Last updated
- Sep 6, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QR0405X | Clinic/Center, Rehabilitation, Substance Use Disorder | – | OR | Yes |
Practice location
1122 Ne 122nd Ave Ste A200Portland, OR 97230-2083
Phone 503-594-4774
Mailing address
1122 Ne 122nd Ave Ste A200Portland, OR 97230-2083
Phone 503-594-4774
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