Healthcare Provider Details

I. General information

NPI: 1447655204
Provider Name (Legal Business Name): ARBOR VITAE NATURAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2014
Last Update Date: 10/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 NE ALBERTA ST
PORTLAND OR
97211-4578
US

IV. Provider business mailing address

827 NE ALBERTA ST
PORTLAND OR
97211-4578
US

V. Phone/Fax

Practice location:
  • Phone: 503-718-4806
  • Fax: 503-766-5979
Mailing address:
  • Phone: 503-718-4806
  • Fax: 503-766-5979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number2056
License Number StateOR

VIII. Authorized Official

Name: DR. LESYA ARIKO LASOTA
Title or Position: NATUROPATHIC DOCTOR
Credential: N.D.
Phone: 503-718-4806