Healthcare Provider Details

I. General information

NPI: 1871921262
Provider Name (Legal Business Name): CLARA CEDARBLADE FASHANA N.D, L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2013
Last Update Date: 10/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 NE SANDY BLVD. SUITE 231
PORTLAND OR
97232
US

IV. Provider business mailing address

3115 NE SANDY BLVD. SUITE 231
PORTLAND OR
97232
US

V. Phone/Fax

Practice location:
  • Phone: 503-701-8766
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC164728
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1984
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: