Healthcare Provider Details

I. General information

NPI: 1538681408
Provider Name (Legal Business Name): GOLDEN RIBBON ACUPUNCTURE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 07/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 NE BURNSIDE RD STE 701
GRESHAM OR
97030-5770
US

IV. Provider business mailing address

1490 NW 4TH ST
GRESHAM OR
97030-5306
US

V. Phone/Fax

Practice location:
  • Phone: 503-839-5510
  • Fax:
Mailing address:
  • Phone: 503-957-1916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberAC183543
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. DAVID ARTHUR VALENCIA
Title or Position: OWNER/ACUPUNCTURIST
Credential: LAC
Phone: 503-839-5510