Healthcare Provider Details

I. General information

NPI: 1689825457
Provider Name (Legal Business Name): FELICIA FERRUZZA LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 NE ALBERTA ST
PORTLAND OR
97211-5003
US

IV. Provider business mailing address

1223 NE ALBERTA ST
PORTLAND OR
97211-5003
US

V. Phone/Fax

Practice location:
  • Phone: 503-206-5309
  • Fax: 503-914-0459
Mailing address:
  • Phone: 503-206-5309
  • Fax: 503-914-0459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC01094
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: