Provider Demographics
NPI:1861205213
Name:QUIROGA, FRANK VICTOR (CADC I/CRM II)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:VICTOR
Last Name:QUIROGA
Suffix:
Gender:M
Credentials:CADC I/CRM II
Other - Prefix:
Other - First Name:VICTOR
Other - Middle Name:
Other - Last Name:QUIROGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CADC I/CRM II
Mailing Address - Street 1:211 SE CARUTHERS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4502
Mailing Address - Country:US
Mailing Address - Phone:503-224-1044
Mailing Address - Fax:971-260-0355
Practice Address - Street 1:17645 NW SAINT HELENS RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97231-1729
Practice Address - Country:US
Practice Address - Phone:503-621-1069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-29
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24-CRM-II-0306101YA0400X
OR25-09-11623101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500855845Medicaid