Healthcare Provider Details

I. General information

NPI: 1518626027
Provider Name (Legal Business Name): ALIAJA ALLISON LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2021
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5039 SE MILL ST
PORTLAND OR
97215-3261
US

IV. Provider business mailing address

5039 SE MILL ST
PORTLAND OR
97215-3261
US

V. Phone/Fax

Practice location:
  • Phone: 727-316-0295
  • Fax:
Mailing address:
  • Phone: 727-316-0295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number425
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: