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Contact Information

DERRICK E CUSTINO, MD
19400 NW EVERGREEN PKWY
HILLSBORO, OR97124-7031
 Phone: 503-645-2762
 Fax: 503-690-5023
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family Medicine

207Q00000X 08 Physician/Family Practice
Indicates primary specialty

NPI Profile & details for DERRICK E CUSTINO · (Male)

NPI # 1013097146
Status Active
Credentials MD
Entity Individual
Enumeration date 10/16/2006
Last updated 07/16/2007 - About 12 years ago
Sole proprietor 1 No
Identifiers
  • OR License # MD22041
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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