| Organization Name: | TIGARD TENDERCARE PC |
| NPI Number: | 1023434271 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JUSTIN RAY MAROSTICA (PRESIDENT) |
| Mailing Address: | 11960 Sw Pacific Hwy Tigard |
| State: | OR US |
| Postal Code: | 972236439 |
| Phone Number: | 5036707088 |
| Fax Number: | |
| NPI Enumeration Date: | 03/12/2014 |
| NPI Last Update Date: | 03/12/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | D9419 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |