Healthcare Provider Details

I. General information

NPI: 1124664396
Provider Name (Legal Business Name): KACIE HINOJOSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2019
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6395 KEIZER STATION BLVD NE
KEIZER OR
97303-2305
US

IV. Provider business mailing address

587 ROSE PARK LN NE
KEIZER OR
97303-4449
US

V. Phone/Fax

Practice location:
  • Phone: 503-589-1597
  • Fax:
Mailing address:
  • Phone: 702-626-4860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: