Healthcare Provider Details

I. General information

NPI: 1215129101
Provider Name (Legal Business Name): VALORA MAE VILLALON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 SE 4TH AVE STE G
HILLSBORO OR
97123-4033
US

IV. Provider business mailing address

245 SE 4TH AVE STE G
HILLSBORO OR
97123-4033
US

V. Phone/Fax

Practice location:
  • Phone: 503-681-9673
  • Fax: 503-844-4093
Mailing address:
  • Phone: 503-681-9673
  • Fax: 503-844-4093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number11065
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: