Provider Demographics
NPI:1154139517
Name:BARANA, ABEYTAX
Entity type:Individual
Prefix:
First Name:ABEYTAX
Middle Name:
Last Name:BARANA
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:ANTONIO
Other - Middle Name:
Other - Last Name:BONILLA
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:531 NE STAFFORD ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-2849
Mailing Address - Country:US
Mailing Address - Phone:503-839-4178
Mailing Address - Fax:
Practice Address - Street 1:18417 SE OAK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-4850
Practice Address - Country:US
Practice Address - Phone:971-727-8026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-18
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program