Shane Anthony Gonzales, C.R.M.

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Practice address

1122 NE 122ND Ave Ste A200
Portland, OR 97230-2083

Phone

(503) 594-4774

NPI assigned

Sep 6, 2024

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sober Living Oregon Recovery Center

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Oregon City, OR
  • NPI 1073081881

  Rehabilitation, Substance Use Disorder

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1725580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725580800000",
    "number": "1245065366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1122 NE 122ND AVE STE A200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972302083",
            "telephone_number": "503-594-4774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1122 NE 122ND AVE STE A200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972302083",
            "telephone_number": "503-594-4774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALES",
        "first_name": "SHANE",
        "middle_name": "ANTHONY",
        "credential": "C.R.M.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-09-06",
        "last_updated": "2024-09-06",
        "certification_date": "2024-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lela Therese Gonzales, MD
• Linda R Gonzales, PH.D.
• Melissa Jean Gonzales
• Pamela Leigh Gonzales, MS
• Pedro Gonzales
• Tara Gonzales
• Ilse Vianey Gonzalez Antonio
• Maria Jose Gonzalez Arredondo, M.S. CCC-SLP
• Christianne Marie Gonzalez Davidson, MD
• Manuel Manuel Gonzalez Gonzalez, MD

• Substance Use Disorder Rehabilitation Clinic/Center in Portland, OR
• Providers in Portland, OR by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.