Tej Miguel Pereira Ambrose
Technician, Personal Care Attendant in Portland, OR. Individual provider (NPI-1).
NPI number1982284865
StatusActive
Last updated in NPPESApr 13, 2021
Details
- NPI
- 1982284865
- Entity type
- Individual (NPI-1)
- Name
- Tej Miguel Pereira Ambrose
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Apr 13, 2021
- Certification date
- Apr 13, 2021
- Last updated
- Apr 13, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3747P1801X | Technician, Personal Care Attendant | – | – | Yes |
Other names
- Mara Ambrose (Professional Name)
Practice location
9125 Sw 55th AvePortland, OR 97219-5018
Phone 503-477-4622
Mailing address
Po Box 8459Portland, OR 97207-8459
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