Provider Demographics
NPI:1487966107
Name:VALENCIA, MARCO POCHOLO RIGOR (MD)
Entity type:Individual
Prefix:
First Name:MARCO POCHOLO
Middle Name:RIGOR
Last Name:VALENCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 A AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3078
Mailing Address - Country:US
Mailing Address - Phone:503-635-2496
Mailing Address - Fax:
Practice Address - Street 1:412 A AVE STE 200
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3078
Practice Address - Country:US
Practice Address - Phone:503-635-2496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-10
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60328795207Q00000X
ORMD185193207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8919708OtherMEDICARE
WA0311916OtherL&I