Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Alma San Juan, AGACNP

Individual provider Acute Care Nurse Practitioner · NPI 1063094621

Alma San Juan, AGACNP is a Nurse Practitioner in Gresham, Oregon. Qualified in 2018, 8 years ago. Practices with Legacy Clinics LLC, a 718-clinician group and accepts Medicare assignment. Licensed in Oregon.

Years since qualifying
8
Licensed in
OR
In the registry since
2021

Practice location Address checks out

25050 SE Stark St Ste 265
Gresham, OR 97030-3388
Phone: (503) 674-1520
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Acute Care Nurse Practitioner (primary) Taxonomy 363LA2100X · Licence 202008006 (OR)

Record details

NPI number1063094621
Entity typeIndividual (Type 1)
GenderFemale
Credentials AGACNP
Sole proprietorNo
NPI enumeratedApril 23, 2021
Last updated in NPPESApril 23, 2021
Certification dateApril 23, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Legacy Clinics Llc — 718 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Gresham