Healthcare Provider Details

I. General information

NPI: 1164936118
Provider Name (Legal Business Name): ARISTA GATES DSOM, EAMP, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2017
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 HILYARD ST
EUGENE OR
97405-3866
US

IV. Provider business mailing address

3525 HILYARD ST
EUGENE OR
97405-3866
US

V. Phone/Fax

Practice location:
  • Phone: 541-228-2387
  • Fax:
Mailing address:
  • Phone: 541-228-2387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC184894
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: