IndividualActive
Shane Gonzales, C.R.M.
NPI 1245065366 · Substance Use Disorder Rehabilitation Clinic/Center · Portland, OR
Provider details
- NPI number
- 1245065366
- Entity type
- Individual
- Primary specialty
- Substance Use Disorder Rehabilitation Clinic/CenterAmbulatory Health Care Facilities
- Credential
- C.R.M.
- Sex
- Male
- Sole proprietor
- Yes
Practice location
1122 Ne 122nd Ave Ste A200
Portland, OR 97230-2083
Phone: (503) 594-4774
Mailing address
1122 Ne 122nd Ave Ste A200
Portland, OR 97230-2083
Registry dates
- Enumerated
- 2024-09-06
- Last updated
- 2024-09-06
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.