Shane Anthony Gonzales, CRM
Shane Anthony Gonzales, CRM is a Substance Use Disorder Rehabilitation Clinic/Center in Portland, Oregon. Practices as a sole proprietor. Licensed in Oregon.
- Licensed in
- OR
- In the registry since
- 2024
Practice location Address checks out
1122 NE 122nd Ave Ste A200Portland, OR 97230-2083
Phone: (503) 594-4774
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Specialties & licences
| Substance Use Disorder Rehabilitation Clinic/Center (primary) | Taxonomy 261QR0405X (OR) |
|---|
Record details
| NPI number | 1245065366 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Credentials | CRM |
| Sole proprietor | Yes |
| NPI enumerated | September 6, 2024 |
| Last updated in NPPES | September 6, 2024 |
| Certification date | September 6, 2024 |
| Mailing address | 1122 Ne 122nd Ave Ste A200, Portland, OR 97230-2083 |
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