Healthcare Provider Details

I. General information

NPI: 1629549191
Provider Name (Legal Business Name): YVETTE BEDROSSIAN LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2018
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 A ST STE 21
ASHLAND OR
97520-1947
US

IV. Provider business mailing address

258 A ST UNIT 21
ASHLAND OR
97520-1947
US

V. Phone/Fax

Practice location:
  • Phone: 541-301-7040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC190746
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: