Healthcare Provider Details

I. General information

NPI: 1578748778
Provider Name (Legal Business Name): LAREINA RULA STARR LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E MCLOUGHLIN BLVD
VANCOUVER WA
98663-3369
US

IV. Provider business mailing address

3337 SW 12TH AVE
PORTLAND OR
97239-2968
US

V. Phone/Fax

Practice location:
  • Phone: 360-693-0400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberMA00013223
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: