Provider Demographics
NPI:1043038375
Name:AZURE, KHEFRI
Entity type:Individual
Prefix:
First Name:KHEFRI
Middle Name:
Last Name:AZURE
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 1:6319 NE 32ND PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-6630
Mailing Address - Country:US
Mailing Address - Phone:206-661-6007
Mailing Address - Fax:
Practice Address - Street 1:975 SE SANDY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1399
Practice Address - Country:US
Practice Address - Phone:503-427-1952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker