Healthcare Provider Details

I. General information

NPI: 1194942920
Provider Name (Legal Business Name): SALOMEIA STAN L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 NW BURNSIDE RD SUITE 6
GRESHAM OR
97030-3745
US

IV. Provider business mailing address

141 SE 194TH AVE
PORTLAND OR
97233-5719
US

V. Phone/Fax

Practice location:
  • Phone: 503-516-7066
  • Fax:
Mailing address:
  • Phone: 503-491-1854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number11677
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: