Provider Demographics
NPI:1699777482
Name:CURIOSO, EVELYN A P
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:A P
Last Name:CURIOSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5329 NE MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-3237
Mailing Address - Country:US
Mailing Address - Phone:503-988-5183
Mailing Address - Fax:503-988-5182
Practice Address - Street 1:5329 NE MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-3237
Practice Address - Country:US
Practice Address - Phone:503-988-5183
Practice Address - Fax:503-988-5182
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD234762084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR286855Medicaid
WA8322992Medicaid
ORH61400Medicare UPIN
OR113199Medicare ID - Type Unspecified