Provider Demographics
NPI:1417194002
Name:HYBRID HEALTH, LLC
Entity type:Organization
Organization Name:HYBRID HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-313-0733
Mailing Address - Street 1:4530 SW FAIRHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-2610
Mailing Address - Country:US
Mailing Address - Phone:503-313-0733
Mailing Address - Fax:
Practice Address - Street 1:9135 SW BARNES RD
Practice Address - Street 2:SUITE 863
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6601
Practice Address - Country:US
Practice Address - Phone:503-313-0733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-19
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty