Healthcare Provider Details

I. General information

NPI: 1700791464
Provider Name (Legal Business Name): MEREDITH MAYA URIBE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 NE REVERE AVE STE 105
BEND OR
97701-4082
US

IV. Provider business mailing address

954 SW EMKAY DR APT 217
BEND OR
97702-0808
US

V. Phone/Fax

Practice location:
  • Phone: 541-323-3488
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number29530
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: