| Marshall Albert Canizalez, AUD | |
| 24076 Se Stark St Ste 230, Gresham, OR 97030-3385 | |
| (503) 488-2600 | |
| (503) 465-5468 | 
| Full Name | Marshall Albert Canizalez | 
|---|---|
| Gender | Male | 
| Speciality | Audiologist | 
| Location | 24076 Se Stark St Ste 230, Gresham, Oregon | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1376205278 | NPI | - | NPPES | 
| 500813168 | Medicaid | OR | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 231H00000X | Audiologist | 147001852 (Illinois) | Secondary | 
| 237600000X | Audiologist-hearing Aid Fitter | (* (Not Available)) | Secondary | 
| 231H00000X | Audiologist | 31054 (Oregon) | Primary | 
| Provider Name | Kaiser Foundation Health Plan Of The Northwest | 
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice | 
| Provider Identifiers | NPI Number: 1184786527 PECOS PAC ID: 5799688230 Enrollment ID: O20040130000799 | 
| Mailing Address | Practice Location Address | 
|---|---|
| Marshall Albert Canizalez, AUD 847 Ne 19th Ave Ste 300, Portland, OR 97232-2686 Ph: (503) 963-2801 | Marshall Albert Canizalez, AUD 24076 Se Stark St Ste 230, Gresham, OR 97030-3385 Ph: (503) 488-2600 | 
| Audiology And Hearing Aid Center Of Gresham Audiologist Medicare: Not Enrolled in Medicare Practice Location: 752 Ne Burnside St, Gresham, OR 97030 Phone: 503-669-7061 Fax: 503-492-3033 | |
| Lottie Renee Rotterman, AUD Audiologist Medicare: Accepting Medicare Assignments Practice Location: 24076 Se Stark St, Suite 230, Gresham, OR 97030 Phone: 503-465-5461 Fax: 503-465-5468 |