Provider Demographics
NPI:1730518754
Name:REBECCA BERZOW ND
Entity type:Organization
Organization Name:REBECCA BERZOW ND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERZOW
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:971-231-4372
Mailing Address - Street 1:15455 NW GREENBRIER PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-7357
Mailing Address - Country:US
Mailing Address - Phone:971-231-4372
Mailing Address - Fax:971-277-6027
Practice Address - Street 1:15455 NW GREENBRIER PKWY STE 100
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-7357
Practice Address - Country:US
Practice Address - Phone:971-231-4372
Practice Address - Fax:971-277-6027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-12
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM1300X
OR1871261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1871OtherLICENSE
OR1164799813OtherINDIVIDUAL NPI