Healthcare Provider Details

I. General information

NPI: 1053563866
Provider Name (Legal Business Name): THRITA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2008
Last Update Date: 10/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7825 SW 35TH AVE
PORTLAND OR
97219-2463
US

IV. Provider business mailing address

7825 SW 35TH AVE
PORTLAND OR
97219-2463
US

V. Phone/Fax

Practice location:
  • Phone: 503-235-4325
  • Fax:
Mailing address:
  • Phone: 503-235-4325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number1611
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number07-997
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number07-997
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number1611
License Number StateOR
# 5
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number07-997
License Number StateAZ

VIII. Authorized Official

Name: MS. JULIE PEFFERMAN
Title or Position: BUSINESS OWNER
Credential:
Phone: 503-235-4325