Westside Pediatric Clinic PC

NPI #1093929226 in Portland, Oregon

Provider Information

NPI Number: 1093929226
Entity Type: Organization
Organization Name: Westside Pediatric Clinic PC
Primary Specialty: Pediatrics
Enumeration Date: May 9, 2007
Last Updated: Apr 11, 2008

Practice Location

Address: 9555 SW BARNES RD
Address 2: SUITE 270
City: Portland
State: Oregon
ZIP Code: 97225
Phone: (503) 297-1025

Authorized Official

Name: MRS. CONNIE LYNN DISTEFANO
Title: ADMINISTRATOR
Phone: (503) 297-1025

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pediatrics	208000000X	Primary

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